aca colonoscopy :: Article CreatorThree Times Your Free Medicare Colonoscopy Could Cost You
Medicare covers that colonoscopy you scheduled, until it doesn't.
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Earlier this year, a family member had a screening colonoscopy. He'd seen the news stories about the Affordable Care Act mandating no out-of-pocket costs, such as co-pays or a deductible. So if this test is supposed to be "free," why did he get a bill? This isn't the first time I've heard of people receiving bills for this procedure. (Full disclosure: That even happened to me.)
Medicare covers a colonoscopy with no Part B deductible, copayment, or coinsurance when the test is done for screening:
Once every 2 years for those at high risk Once every 10 years for those who are at average risk, and Four years after a flexible sigmoidoscopy for those who are at average risk. When there are twists to the rules, there can be cost-sharing as can happen in the following three situations.
The physician removes a polyp or tissue for a biopsy.
Medicare covers a screening colonoscopy, a test performed to check that the person's health is on track and to identify whether any additional testing is necessary. When the doctor removes a polyp or tissue, the test becomes diagnostic, to confirm or eliminate potential diagnoses. In that case, a 15% Part B coinsurance applies, but not the Part B deductible.
A high-risk individual has a colonoscopy two years in a row.
Medicare defines high risk of developing colon cancer as someone who has a family history of the disease, has had inflammatory bowel disease, or has had colorectal cancer or colorectal polyps. These individuals qualify for a free screening every two years. If a high-risk person has the procedure every year, Medicare deems this not to be medically necessary and will not cover the procedure.
The doctor who performs the procedure is out-of-network.
This is an issue for those who elected Medicare Advantage. Using an out-of-network physician can cost the plan member. How much depends on the type of plan.
A health maintenance organization (HMO) plan will pay only for routine (non-emergency) services in-network. It can charge the patient the full cost for an out-of-network screening colonoscopy.
A preferred provider organization (PPO) plan will cover out-of-network services. But pay attention to these two facts. One, the physician has no obligation to see out-of-network patients; and two, the services can cost more, sometimes a percentage of the entire cost.
More Important Points about Diagnostic Colonoscopies
In- and out-of-network physicians are not a concern for those who have Original Medicare (Part A and Part B), with or without a Medigap policy (Medicare supplement insurance). They should choose a physician who accepts Medicare assignment. There are some high-risk individuals with significant medical issues who need colonoscopies more frequently than every two years. Medicare will cover these as medically necessary diagnostic procedures. The 20% Part B coinsurance will apply but not the deductible. A Medigap plan (Medicare supplement insurance) will cover the Part B coinsurance. Instead of the coinsurance, Medicare Advantage plans can charge a copayment for diagnostic colonoscopies. Check the plan's Evidence of Coverage or talk with a plan representative. Medicare Advantage plans may require prior authorization for diagnostic colonoscopies. Mention "colonoscopy" to a group of seniors and you'll likely get a collective groan. It is not something they look forward to or want to do. However, it is definitely worth the time. A recent study on the benefits of colonoscopy screening, published in the New England Journal of Medicine, estimated a 31% decrease in the risk of colorectal cancer and a 50% decrease in colorectal cancer–related death. With statistics like these, can a colonoscopy be any more traumatic than seeing a dentist for teeth cleaning and examination? Both are extremely beneficial. And with a little knowledge, you won't experience any sticker shock.
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Colonoscopy Preparation: What You Should Do In Advance?
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To prepare for a colonoscopy, you may need to avoid fiber in the days leading up to your appointment and follow a clear liquid diet beginning the day before. Preparation also involves taking laxatives.
A colonoscopy exam allows your doctor to see the inside of your large intestine (colon) and rectum. It's one of the most efficient ways for doctors to:
It's also an exam many people dread. The test itself is brief, and most people are under general anesthesia during it. You won't feel or see anything, and recovery generally takes only a few hours. Preparing for the exam, however, can be unpleasant.
That's because your colon needs to be empty and clear of waste. This requires a series of strong laxatives to clean your intestines in the hours prior to the procedure. You'll need to stay in a bathroom for several hours, and you'll likely deal with some uncomfortable side effects, like diarrhea.
When your doctor requests the colonoscopy, they'll provide you with information on how to prepare for it, what products to use, and what you can expect. This information will likely break down what you need to do by the day.
Although the timeline below can give you a general understanding of the process, your doctor is your best resource if you have any questions or concerns.
Get a head start on your preparations and head to the store at least a week before your colonoscopy. Here's what you'll need:
Laxatives
Some doctors still prescribe laxative medication. Others recommend a combination of over-the-counter (OTC) products. Buy the products your doctor recommends, and if you have any questions, call your doctor's office before the day you're meant to prep.
Moist wipes
Regular toilet paper may be too harsh after several trips to the bathroom. Look for moist or medicated wipes, or wipes with aloe and vitamin E. These products contain ingredients that can soothe irritated skin.
Diaper cream
Before your prep starts, cover your rectum with a diaper cream like Desitin. Reapply throughout the prep. This will help prevent skin irritation from the diarrhea and wiping.
Approved foods and sports drinks
The week of your colonoscopy, you're going to eat foods that are easier to pass and less likely to cause constipation. Stock up on those now.
They include:
You'll need at least 64 ounces of a drink to take your laxative, so plan accordingly. Sports drinks or light-colored, flavored beverages can help make taking the medication easier.
At this time, you should start adjusting your diet to include foods that are easier to pass through your digestive system.
Low fiber foods
Switch to low fiber foods at least five days before your exam. Some options include:
white bread pasta rice eggs lean meats like chicken and fish well-cooked veggies without the skin fruit without skin or seeds. Soft foods
Switching to a soft-food diet at least 48 hours before the colonoscopy may make your preparation easier. Soft foods include:
scrambled eggs smoothies vegetable purees and soups soft fruits, like bananas Foods to avoid
During this time, you also need to avoid foods that can be hard to digest or get in the way of the camera during your colonoscopy. These include:
fatty, fried foods tough meats whole grains seeds, nuts, and grains popcorn raw vegetables vegetable skins fruit with seeds or skins broccoli, cabbage, or lettuce corn beans and peas Medications
Ask your doctor whether you should continue to take any prescription medications during your prep or if you should stop until after the procedure. Be sure to also ask about any vitamins, supplements, or OTC medications you use daily.
No matter your diet in the days before your colonoscopy, you must switch to a liquid-only diet the whole day before your exam. That's because your body needs time to eliminate waste from your colon, so your colonoscopy is a success.
If your colon isn't clear, your doctor may have to reschedule the appointment for a later date. That means you'll need to prep again in the future.
It's important you stay hydrated during this time. You can eat and drink any clear liquids you want, but a good rule of thumb to follow is eight ounces per hour that you're awake. Chug a glass of water or sports drink every hour, and you shouldn't have any issues.
It's time to begin cleaning out your colon of any remaining waste. To do this, your doctor will prescribe a strong laxative.
Most doctors now recommend a split dose of laxatives: You take half the mixture the evening before your exam, and you finish the second half six hours before your exam. You may also take pills at the beginning of the process.
If your exam is early in the morning, you may begin the process 12 hours before you're scheduled to start your colonoscopy and finish the dose before midnight.
The laxative may be difficult to swallow because of its bitter taste. Try these techniques to make it easier:
Mix it with a sports drink. Flavored drinks can cover any unpleasant taste. Chill it. Mix the drink and laxative 24 hours before you're set to begin the prep. Refrigerate it so the drinks are cold. Chilled drinks are sometimes easier to swallow. Use a straw. Place the straw at the back of your throat where you're less likely to taste it when swallowing. Chase it. Squeeze a bit of lemon or lime juice in your mouth after you drink the laxative to kill the taste. You can also use hard candy. Add flavorings. Ginger, lime, and other aromatics add a lot of flavor to liquids. That may make drinking the laxative more pleasant. Once you take the laxative, your intestines will begin pushing out any remaining waste very quickly. This will cause frequent, forceful diarrhea. It can also cause:
cramping bloating abdominal discomfort nausea vomiting If you have hemorrhoids, they may become inflamed and irritated.
These tips may help make you more comfortable during the process:
Set up shop in the bathroom. You'll be spending a lot of time in here, so make yourself comfortable. Bring a computer, tablet, TV, or other device that can help you pass the time.
Use comfort products. You should have purchased moist or medicated wipes, as well as creams and lotions, prior to your prep. Now's the time to use them to make your bottom more comfortable.
Don't drink anything — even water — two hours before your procedure. This step is important to help prevent you from getting sick after your procedure. People who drink right before the procedure risk getting sick and breathing vomit into their lungs. Some hospitals request a longer window without liquids, so follow their instructions.
The prep for a colonoscopy, as well as the recovery, may be uncomfortable and inconvenient. However, the alternative — not finding and diagnosing potential problems, including colon cancer — is much worse.
Be sure to follow any directions your doctor provides, and don't be afraid to ask if you have any questions. It's also worth noting that if your colonoscopy is successful, you may not need another one for 10 years.
Colonoscopies Available At Disney World?
Claim:
Visitors to Disney World can now get colonoscopies in an effort to encourage more adults to get routine colon cancer checks.
On May 29, 2024, the TikTok account Mouse Trap News published a video claiming Walt Disney World was offering colonoscopies to visiting adults.
The TikTok video's narrator claimed:
You can now have your colonoscopy inside Disney World. This is a way to encourage adults to go in for routine colon cancer checks. Essentially, you can book an appointment with an approved doctor through the My Disney Experience App. Then, when it is your day, you will visit a new building coming to the Magic Kingdom called the "Mickey Mouse Colon House."
This will be a Disney-themed doctor's office on Main Street USA. The doctors will even be dressed in Disney costumes to add to the experience. Patients will scan in using their fingerprint and MagicBand. After the procedure, they will be given a button that says "I Was Screened at Disney."
However, none of the claims made in the video are true. The footage originated from a TikTok account that describes its output as being satirical in nature, as follows: "Real Disney News That is 100% FAKE."
Mouse Trap News also published an article about the satirical news on its website, where it similarly describes its content as "satire and parody":
Mouse Trap News was created on a whim to have some fun and write stories about Disney we wish were true. Some Disney sites write deceptive stories for clicks. We write 100% made-up parody and satire stories for your enjoyment. We also hope that Disney sees how much people like some of our stories and decide to actually make one of our stories a reality!
In the article on the website, Mouse Trap News states:
This is yet another medical procedure happening at Disney World. We reported earlier on how women can give birth and have abortions at Disney World. The goal of all of these is to encourage guests to make smart medical decisions and do it at the most magical place on earth. What's more magical than a colonoscopy at Disney World?
For background, here is why we sometimes write about satire/humor.
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