While you were asleep, the doctor that removed a polyp from your rectum while undergoing what you thought was a free preventative procedure, also removed some money from your wallet to cover the costs.

Welcome to the world of American-style health care, where you don’t know what the bill is until after you’re sent home following whatever was done to you is over. That’s not fake news when it comes to the twists and turns embedded in America’s health care delivery system, where for-profit health care is the underlying foundation for the most expensive system of its kind in the world.

Medicare X-Men

But like legislative X-Men from Washington come to right a wrong, Ohio Sen. Sherrod Brown has teamed up with three other senators to change Medicare rules so that seniors undergoing a free preventive procedure don’t wake up to a wallet-tapping surprise when their doctor removes a poly that could turn cancerous if not removed.

Sen Brown and his three co-sponsors—Roger Wicker (R-MS), Ben Cardin (D-MD), and Susan Collins (R-ME)—introduced  The Removing Barriers to Colorectal Cancer [CRC] Screening Act to make sure seniors are not charged with unexpected bills after colonoscopies. The bill was introduced in March to coincide with March being “Cancer Awareness Month.”

According to Brown’s staff, Medicare currently charges seniors for colonoscopies when a polyp is removed during the procedure even though colorectal cancer screenings are promoted as a free service under Medicare.

The act—S.479, would amend title XVIII of the Social Security Act to waive coinsurance under Medicare for colorectal cancer screening tests, regardless of whether therapeutic intervention is required during the screening—would make a long-overdue fix to Medicare to ensure seniors aren’t charged for a colonoscopy – regardless of whether or not a polyp or tissue is removed.

Removing harmful tissue during these procedures is key to preventing cancer, yet the fear of having to pay unexpectedly could prevent Medicare recipients from getting these important screenings, Brown’s staff said today via email.

“Let’s face it – colonoscopies are already unpleasant. We shouldn’t make matters worse by charging seniors for what’s supposed to be free under Medicare,” the senator said in prepared remarks. “Preventive life-saving screenings should be available to seniors at no out-of-pocket cost, especially when a doctor makes the decision to remove a potentially harmful polyp.”

Seniors should have peace of mind that their colorectal cancer screenings are not going to be followed by unexpected medical costs,” Sen. Wicker said, adding, “Most colorectal cancer is preventable, making these screenings vital to saving lives. This legislation is a sensible way to streamline preventive care for Medicare beneficiaries and can reduce costs in the long run.”

Sen. Cardin, a member of the Senate Finance Health Care Subcommittee, said, “We want more Americans to opt for this highly effective method of colorectal cancer prevention, without worrying about unexpected costs.”

Sen. Collins wants to improve health and save lives. “We must work to ensure that all Americans have access to these life-saving tests,” she said, noting that removing financial barriers to colonoscopies can prevent more cases of colorectal cancer.

CRC: Second Leading Cause Of Death

For anyone who has not undergone a colonoscopy, fear not, it’s not as bad as it sounds. The procedure enables the detection and removal of polyps that could become cancerous, as well as for the early detection of colorectal cancer when treatment can be most effective. Seniors covered by Medicare, under current law, are eligible for colorectal cancer screenings without out-of-pocket costs.

But wait, if a physician takes a further preventive action during the screening, including the removal of a polyp, the patient is billed as if the procedure was treatment rather than prevention in spite of being knocked out from anesthesia at the time.

Knowing whether a polyp will be removed during a screening colonoscopy in advance is currently impossible. Medicare beneficiaries do not know whether or not their screening colonoscopy will be fully covered until after the procedure is over, Brown’s office notes, correctly.

“This potential cost could lead to Medicare beneficiaries electing to forgo this important preventive screening, even though colorectal cancer screening is promoted as a service without cost-sharing under Medicare,” the email said.

Private insurers cannot impose cost-sharing for a screening that leads to polyp removal, but the law allows Medicare to charge fees if a polyp is removed.

If “The Removing Barriers to Colorectal Cancer Screening Act” becomes law, it would correct this problem through a waiver for cost-sharing under Medicare for preventive colonoscopies even if a polyp or tissue is removed.

 
  • Susan Riley

    Bravo to Sen. Brown for introducing SENSIBLE legislation. A couple of years ago I had a screening colonoscopy. Benign polyps were discovered and removed. Because I was on Medicare and knew about this ‘billing’ rule, I was very worried about the costs..

    (FWIW, the total “retail” cost of a screening colonoscopy – as billed to my insurance co. was somewhere north of $3,500.00.)

    However . . . because I chose to receive my Medicare coverage through a Medicare Advantage program offered by Anthem BCBS, I didn’t have to pay any additional costs.

    Caveat: I did have to pay a $10.00 co-pay to the lab for analysis of the polyps, and I was happy to do so.

Looking for something?

Use the form below to search the site:


Still not finding what you're looking for? Drop a comment on a post or contact us so we can take care of it!