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Re: Medicare doesn't pay for followup colonoscopy

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I had my first two a while back with 5-yr recheck. [Each time there were polyps removed. My MD's under regular pre-Medicare insurance paid 100% and the specialists said re-check every 5 years because ot those results and family history of colon-rectal cancer.]  Medicare MD first check up: no coming back every 5 years. Not covered by Medicare. Will check on my supplemental policy. Good idea. Thank you!

Might be worth paying for anyway, the alternative would be BAD if things are going wrong 'down there'. Right? 

I guess Medicare figures if you die, more money for the top 1% of the top 1%.  

Maybe I will join the GOP and see if there is better medical coverage. 

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Re: Medicare doesn't pay for followup colonoscopy

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@intersanwrote:

I recently had my first colonoscopy at age 70. I agree that I put it off too long. I have diverticulosis and the doctor also removed 3 polyps that are pre-cancerous. She told me to come back in 6 months for a repeat colonscopy which, I assume, is necessary. I've read that Medicare only pays for colonoscopies 24 months apart. I will probably have to pay out of pocket for this new one. I have United Health Care as a supplemental. Will they pay anything toward it?


It ALL depends on why the doctor is wanting to do it so soon and it is all in the coding as to that reason.

 

IF it is another "screening", then you are going to have to pay for all of it because as you state, Medicare only covers another one 24 months apart even if you are determined to be high risk.  Your supplemental plan only pays when Medicare pays.

 

However, if the doctor is doing it as a "diagnositic" measure, then it is determined to be a "medically necessary" procedure and Medicare will cover it in the regular way - paying 80% of their negotiated price, with you or your supplemental plan picking up the 20%.  As long as the doctor accepts Medicare Assignment.

 

For this fast a turn around, I am guessing that this is a diagnostic procedure.

Talk to your doc about the reason - What did they see in the last one that makes another one done so soon necessary?  What are they expecting to see and do with this one?

 

Here is what Medicare says. 

Medicare.gov - Colorectal Cancer Screenings

 

Screening Colonosopy -

Medicare covers this test once every 24 months if you're at high risk for colorectal cancer.

If you aren't at high risk for colorectal cancer, Medicare covers this test either: 

  • Once every 120 months
  • 48 months after a previous flexible sigmoidoscopy
Your costs in Original Medicare

You pay nothing for the screening colonoscopy, if your doctor or other qualified health care provider accepts assignment.

A screening colonoscopy can become a diagnostic colonoscopy when:

  • The screening colonoscopy results in the biopsy or removal of a lesion or growth
  • The biopsy or removal happens during the same visit as the screening colonoscopy

When the colonoscopy procedure is considered diagnostic:

  • You may pay 20% of the Medicare approved amount for your doctor's services
  • You may pay a copayment in a hospital setting
  • The Part B deductible doesn't apply
Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

 

 

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Re: Medicare doesn't pay for followup colonoscopy

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@intersanwrote:

I recently had my first colonoscopy at age 70. I agree that I put it off too long. I have diverticulosis and the doctor also removed 3 polyps that are pre-cancerous. She told me to come back in 6 months for a repeat colonscopy which, I assume, is necessary. I've read that Medicare only pays for colonoscopies 24 months apart. I will probably have to pay out of pocket for this new one. I have United Health Care as a supplemental. Will they pay anything toward it?


I believe that is the normal protocol yet since you had a problem and the Doc told you to return in six months, I think you have a chance of getting Medicare to pay. I would call Medicare and explain the situation and that the Doc said to return for a follow up colonoscopy in six months. You may have to get your Doc to vouch that the above is true. You only have a call to risk.  Good luck.

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Medicare doesn't pay for followup colonoscopy

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I recently had my first colonoscopy at age 70. I agree that I put it off too long. I have diverticulosis and the doctor also removed 3 polyps that are pre-cancerous. She told me to come back in 6 months for a repeat colonscopy which, I assume, is necessary. I've read that Medicare only pays for colonoscopies 24 months apart. I will probably have to pay out of pocket for this new one. I have United Health Care as a supplemental. Will they pay anything toward it?

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