The new benefit for preventive colonoscopies in the healthcare reform law is complicating collection efforts for providers such as gastroenterologists' offices and ASCs, according to a report by Kaiser Health News.
While the healthcare reform law waives out-of-pocket charges for screening colonoscopies, patients can suddenly be stuck with a bill of several hundred dollars if a polyp is found and removed, turning the procedure into an uncovered therapeutic visit.
Studies show that colonoscopies find a polyp in at least 25 percent of men and 15 percent of women.
The change from a screening to therapeutic visit is hampering physician offices' usual practice of asking for out-of-pocket charges before the procedure. This problem is raising concerns among the American Cancer Society, American College of Gastroenterology and other physician and patient advocacy groups.
Medicare and at least two large private insurers, Kaiser Permanente and Health Net, are charging fees to patients when polyps are discovered, while seven other major insurers are not. A spokesman for America's Health Insurance Plans said the issue needs clarification from federal officials.
Read the Kaiser Health News report on gastroenterology.
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Study Links Physician Fatigue to Inaccurate Colonoscopy Reads