Does Blue Cross Blue Shield Cover Medicare Colonoscopies?
- Colonoscopies are procedures that help detect colon cancer and other conditions. Some Blue Cross Blue Shield Medicare Advantage plans may help pay for covered colonoscopies. Learn more.
A colonoscopy is a type of medical procedure in which a physician utilizes a specialized imaging device called a colonoscope to examine the inside of the colon and rectum. Colonoscopy screenings for colorectal cancer are recommended for all adults between the ages of 45 and 75.
Original Medicare (Part A and Part B) typically covers colonoscopies once every 24 months for beneficiaries who are considered at risk for developing colon cancer.
All Medicare Advantage (Medicare Part C) plans – including those offered by Anthem Blue Cross Blue Shield – are required to cover at least the same benefits as Original Medicare, which means Anthem BCBS Medicare Advantage plans also cover colonoscopies when you meet eligibility requirements.
Some Medicare Advantage plans may offer additional benefits Original Medicare doesn't cover, such as prescription drugs you may need to treat conditions related to your colon health.
Does Blue Cross Blue Shield Medicare Cover Colonoscopy Procedures?
Anthem Blue Cross Blue Shield typically covers colonoscopies for men and women aged 50 or older if they're considered at risk for developing colon cancer. Plans might cover all costs of colonoscopy procedures for plan members who use in-network providers; however, costs for additional procedures, such as biopsies, may not be covered.
Original Medicare covers 100% of colonoscopy exams for recipients who use physicians or health care providers who accept assignment.
If the physician performs a biopsy or removes suspicious tissue during a colonoscopy procedure, the Medicare recipient may be required to pay 20% of the total Medicare-approved amount for the physician's services and/or a separate facility copayment if the procedure takes place in an outpatient hospital setting.
This means that an Anthem Blue Cross Blue Shield Medicare Advantage plan will cover your colonoscopy with at least the same level of coverage as Original Medicare. Some plans may require a lower (or $0) copay or coinsurance for your colonoscopy, though you should check with your plan provider directly for cost and coverage details.
What Are The Risk Factors for Developing Colon Cancer?
Some common risk factors for colon cancer include a family history of colorectal cancer and/or colorectal polyps, obesity, excessive alcohol consumption and tobacco use. Individuals with inflammatory bowel disease or ulcerative colitis may also be at higher risk for the disease.
Lifestyle factors that may contribute to colon cancer include diets low in fruits and vegetables and a lack of daily exercise and physical activity.
How Do People Prep for Colonoscopies?
Individuals scheduled for colonoscopy procedures are usually provided with specific instructions to prepare the colon for the insertion of the colonoscope. Prep instructions include:
- Eating low-fiber foods the second and third day prior to the procedure
- Switching to a clear liquid diet the day before the procedure
- Consuming liquid laxative the evening before and the day of the procedure to clean out the colon
- Coordinating a ride home after the procedure
Are Colonoscopies Painful?
People are usually completely sedated during colonoscopies, so the actual procedure is generally pain-free. After the procedure, individuals may experience symptoms, such as mild stomach pain, gas, diarrhea and constipation.
Serious side effects or complications are generally rare with colonoscopies, but heavy bleeding and/or severe pain following the procedure should be assessed by a medical professional.
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