Q. I thought that colonoscopies are supposed to be performed at no cost under the Affordable Care Act. I need a colonoscopy, and I have no health insurance. My sister died at 42 of colorectal cancer, and I have the same symptoms that she had. A gastroenterologist recommended that I get a colonoscopy. The cost of the procedure will be $1,600, and I need to pay half of the money before having the procedure. What can I do?
A. You’re in a tough spot. Under the health care law, most health plans must cover preventive services that are recommended by the U.S. Preventive Services Task Force without any out-of-pocket cost to patients. The services covered include colonoscopies to screen for colorectal cancer.
But if you don’t have health insurance, you can’t take advantage of the free preventive care provisions. Even if you did have coverage, because you have symptoms, your colonoscopy would be considered a diagnostic procedure rather than a standard screening, and that wouldn’t generally qualify as a preventive service under the law.
The federal Centers for Disease Control and Prevention runs a program that offers free colonoscopies in 25 states and four tribal areas, although rules for eligibility can vary by state. There may also be local programs in your area. Call the American Cancer Society National Cancer Information Center (1-800-ACS-2345) for information, or check with your state health department, says Alissa Crispino, a spokesperson for the ACS Cancer Action Network.
This story was updated at 5:30 p.m. to add that state can set rules for eligibility for the CDC program.
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