How Much Does a Colonoscopy Cost?
A colonoscopy is a preventative diagnostic procedure used to detect changes or growths in the colon and rectum. It is one of medicine’s most important tools for detecting colon cancers while they are still treatable. How much does a colonoscopy cost? Read on to learn about the price of this procedure based on whether or not you currently have health insurance coverage.
What is a Colonoscopy?
A colonoscopy is an outpatient medical procedure used to examine the large intestine (colon) and rectum. Colonoscopies are usually undergone at both hospitals and other outpatient facilities.
The process involves the insertion of a long, flexible tube called a colonoscope into the rectum. Colonoscopes are fitted with small, fiber-optic cameras that allow gastroenterologists to view the inside of the colon. Most colon cancers begin as polyps, or small growths within the colon. Early polyp removal can prevent these growths from becoming cancerous.
According to the American Cancer Society, colon cancer is the third most fatal cancer among men and women in the United States. The American Cancer Society also states that the rate of people being diagnosed with colon or rectal cancer has dropped each year since the mid-1980s. The main reasons for this are colonoscopy screenings and changes in lifestyle-related risk factors.
Medical experts recommend that people at average risk of colorectal cancer should have their first screening colonoscopy at age 50, then repeat the exam once every 10 years. The United States Preventive Services Task Force recommends patients at average risk of colorectal get their first colonoscopy as early as age 45.
Need a colonoscopy but unsure what it might cost? Read on to learn more about how much colonoscopy procedures cost.
What Does the Price of a Colonoscopy Include?
When patients undergo a colonoscopy, the price is not just for the test itself. The following fees are commonly included in the overall cost of the procedure:
- Primary care physician fee: A fee paid to your doctor to discuss initial treatment or recommended diagnostic exams
- Gastroenterologist consultation: Pre-procedural meeting with a specialist to discuss preparation for the test, potential side effects, and overall expectations
- Anesthesia/sedative fees: Cost to sedate patients so they are comfortable during the exam
- Pathology fees (if you have tissue removed and examined): Costs related to the removal and examination of tissues such as polyps during the procedure
- Facility fees: General hospital or outpatient surgery center fees which cover all administrative, nursing costs, and equipment for a colonoscopy
Some preventative services like colonoscopies can be expensive without insurance coverage. The total cost of the procedure will vary depending on what kind of health insurance coverage you have.
How Much Does a Colonoscopy Cost With Insurance?
According to the Business Group on Health, the average deductible for large employers’ most popular plans in 2021 was $1,500 for in-network care for an individual employee and $3,000 for family coverage.
It’s important to remember to review the specifics of your health insurance plan prior to any medical procedure, preventative or otherwise. Make sure your gastroenterologist is in your insurance plan’s network of providers. Undergoing a colonoscopy outside of your plan’s network can increase out-of-pocket costs considerably.
How Much Does a Colonoscopy Cost With Medicare?
If you have Medicare coverage, colonoscopies can be conducted at no charge to you. Medicare covers colonoscopies once every two years if you’re a patient considered at high risk for colorectal cancer. If you are not at high risk for colorectal cancer, Medicare covers the cost of the test once every 10 years.
Patients with Medicare typically pay around 20% of the Medicare-approved amount for the cost for the colonoscopy procedure if a polyp is found, in addition to making a copayment on the outpatient facility charges.
How Much Does a Colonoscopy Cost Without Insurance?
To get a more precise idea of what a colonoscopy screening test costs in your region, use the Compare.com health care cost comparison tool. If you are uninsured and in need of a colonoscopy, some low or no-cost alternatives to paying out of pocket are discussed below.
Low-Cost Colonoscopy Options
If you are uninsured or in between health plans, the following low-cost options can make sure you can still undergo this key preventative service without very high out-of-pocket costs.
Health Insurance Coverage Through the Affordable Care Act
The Affordable Care Act (ACA) mandates that private insurers cover the costs of colorectal cancer screening tests, as recommended by the United States Preventive Services Task Force.
The ACA stipulates that patients should not incur out-of-pocket costs, including co-pays or deductibles, for these screenings. It’s important to note that the ACA stipulation does not apply to health care plans that were in place before the ACA was passed on March 23, 2010.
Health care plans that were in place before the passage of the ACA are referred to as “grandfathered” plans. However, it’s important to contact your health care provider in such cases as it still may have screening cost coverage requirements dictated by state laws or other federal laws.
Ambulatory Surgery Centers
Ambulatory surgery centers can sometimes charge less than half of what hospitals charge for colonoscopy procedures. Ambulatory surgery centers are licensed, freestanding outpatient facilities that are not affiliated with hospitals and do not require hospital admission for preventative surgeries.
A sigmoidoscopy is a preventative test that’s similar to a colonoscopy, but one that only checks a smaller portion of the large intestine.
Unlike a colonoscopy, sigmoidoscopy requires less intense preparation, but may include fasting periods, and sometimes medications that induce diarrhea to clear the colon. This colon cancer screening technique is less invasive than colonoscopy, and it often costs considerably less. However, it does not evaluate the whole of the colon.
Talk to your doctor about the benefits and risks of having a sigmoidoscopy as an alternative to a colonoscopy, as each patient’s circumstances are different.
Other Testing Alternatives
According to the New York Times, alternative tests such as at-home screenings may be a feasible, low-cost, and less invasive alternative to colonoscopy screenings. However, all patients, particularly those at a high risk of colon cancer, are encouraged to discuss alternative preventative care measures with a doctor or their primary care physician before opting to forego a traditional colonoscopy.
Moving Forward With Diagnostic Tests
The thought of paying for any medical procedure without insurance is scary. That said, failure to have a diagnostic colonoscopy when it is time could result in undetected illnesses that could make the cost of this simple test pale in comparison. According to the American Society for Gastrointestinal Endoscopy, the cost of treating advanced colorectal cancer is estimated to be over $250,000 per patient.
Interested in learning how much a colonoscopy and other preventative procedures cost in your region? Use the Compare.com medical procedure cost comparison tool to break down the price for common procedures and treatment in and around your city to help you cut down on medical costs.