Your Colonoscopy Is Covered, But Surprise! The Prep Kit May Not Be

With summer vacations coming up, one reader this week asked about travel insurance, while others had questions about coverage of preventive services, including costs related to colonoscopies.

Q. We know now that anesthesia for a screening colonoscopy is covered with no cost sharing  as a preventive service under the health law. As a plan administrator, I am also struggling to find guidance on how to handle bowel prep kits for colonoscopies. Can you help?

A. Without some sort of bowel cleansing preparation–often a powerful laxative that scours out the colon–the exam, which involves inserting a flexible tube with a camera on the end into the rectum and snaking it through the large intestine to look for polyps and other abnormalities, couldn’t be done. When the federal government clarified last month that under the health law’s preventive services provisions consumers can’t be charged for anesthesia they receive as part of a screening colonoscopy, it didn’t address other services that are generally part of the exam, including bowel prep kits.

“The federal coverage mandate doesn’t include any ancillary services,” including bowel prep kits or even the pre-screen consults that can cost as much as $250, says Citseko Staples-Miller, senior specialist for state and local campaigns for the American Cancer Society Cancer Action Network. Some states may impose additional coverage requirements on insured plans. But aside from anesthesia, plans can generally decide for themselves under federal law whether to cover such services without cost sharing.

Q. Why should I buy travel insurance if it won’t cover pre-existing medical conditions? That’s exactly what I’d probably need it for.

A. It’s often easy to get that coverage if you need it. Most comprehensive travel insurance policies cover pre-existing conditions if you buy coverage within 14 to 21 days of making your first trip payment, says Lynne Peters, insurance product manager at insuremytrip.com, a website that offers plans from 25 companies.

Even if you miss that window, as long as you haven’t recently needed medical attention for your diabetes or bad back, for example, you may not run into trouble.

“Most policies have relatively short ‘lookback’ periods,” Peters says. That means that if you file a claim, the insurer will only review your medical records for pre-existing conditions for a specified period before your policy’s effective date, typically 60 to 180 days. As long as you haven’t received any medical treatment, testing, medication changes or recommendations from a physician related to your pre-existing condition during that timeframe, the claim wouldn’t be denied on that basis, Peters says.

Q. With too many children affected by prenatal exposure to illicit drugs, alcohol or tobacco, why doesn’t the federal government include prenatal screening in its list of preventive services that must be covered without cost sharing?

A. It’s standard practice to screen pregnant women for alcohol, tobacco and illicit drug use and intimate partner violence during their initial visit with an obstetrician/gynecologist, says Dr. Lisa Hollier, an obstetrician/gynecologist at the Center for Children and Women in Houston who is assistant secretary of the executive board of the American Congress Of Obstetricians And Gynecologists.

Screening involves asking a series of questions about substance use. It doesn’t involve urine or other tests that might discourage women from getting appropriate prenatal care because they fear running into legal problems, according to ACOG. 

In addition, the health law requires most plans to cover preventive services recommended by the U.S. Preventive Services Task Force without requiring consumers to pay anything out of pocket. The task force recommends that tobacco and alcohol screening be performed and counseling provided if necessary for pregnant women. It concludes that there’s not enough evidence to assess whether screening pregnant women for illicit drug use is clinically useful.

As a practical matter, the task force’s lack of endorsement for drug screening for pregnant women doesn’t mean plans won’t cover it.

While screening isn’t generally a concern, treatment can be.

“There are not many professionals who have specific expertise in managing these problems with pregnant patients,” Hollier says.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Syndicate