GREENSBORO, N.C. — Cologuard is an at-home test to screen for colon cancer. I've used it, but now some folks who have used it are getting surprise medical bills.
“I thought, this screening at home that I can do sounds pretty easy compared to a full-blown colonoscopy. They said yes, it would be fully covered, 'cause I didn't want to be caught with an unexpected bill,” said Lianne Bryant.
The test came back positive so she scheduled a colonoscopy and afterward, she began getting big bills totaling $1,900.
Under the Affordable Care Act, only routine screening tests are covered because Bryant's Cologuard result was positive, her colonoscopy was coded as an uncovered "diagnostic" test. As it turns out, she would only have been fully covered if she had never used Cologuard in the first place.
CBS News surveyed eleven of the largest health insurers in the US to see what they would do in situations like Bryant's. Seven insurance companies didn't respond. The four who did, Blue Cross Blue Shield, Anthem Blue Cross, United Health Care, and Health Care Service Corporation told CBS that coverage decisions vary, and how much a consumer will pay depends on how doctors code the colonoscopy procedure
“The fact that the people who are deemed to be at higher risk, that it's not easy financially or otherwise to get the colonoscopy makes absolutely no sense to me,” said University of Michigan's Dr. Mark Fendrick
Cologuard now has new language on its website saying ‘although millions of patients have access to this follow-up colonoscopy with no out-of-pocket costs...not all do’.
You should contact your insurance company before you take either test and ask how it may affect future tests.