The Affordable Care Act requires that insurance policies cover certain preventative services, such as colonoscopies, at no cost to the patient.  However, the insurance industry has established strict guidelines for what defines a screening/preventative service.  The guidelines may exclude patients with current symptoms, history of gastrointestinal disease, or a personal or family history of colon polyps or colon cancer from meeting the definition of a screening/preventative colonoscopy.  Please understand that your primary care provider may refer you for a “screening” colonoscopy, however, you may not meet the guidelines for a screening/preventative colonoscopy benefit, according to your insurance policy guidelines.

Arizona Gastroenterology ltd. (AGI) defines colonoscopies in three categories:

• Diagnostic/Therapeutic Colonoscopy-patient would have gastrointestinal symptoms such as, but not limited to, diarrhea, constipation, rectal bleeding, abdominal pain, anemia, personal history of gastrointestinal disease, or abnormal test results (ie: ultrasound or CT scan).The procedure is usually subject to copay, coinsurance and/or deductible.
• Surveillance/High Risk Colonoscopy-patient would not have any current symptoms or history of gastrointestinal disease. However, the patient has a personal or family history of colon polyps and/or colon cancer. Patients in this category usually have colonoscopies every 2-5 years. The procedure may be subject to copay, coinsurance and/or deductible.
• Screening/Preventative/Average Risk Colonoscopy-patient has no symptoms, is 50 years old or older, has no history of gastrointestinal disease, and no personal or family history of colon polyps and/or cancer. Patients in this category usually have colonoscopies every 10 years. If these guidelines are met, the procedure may be covered at 100% depending on your insurance policy benefits.