Colonoscopies are tests used to detect colon cancer, which is the third most common cancer in the U.S.
Premera covers colonoscopies as part of your preventive checkups starting at age 50. We cover repeat screenings every 5 years.
At-home screening options have made colon cancer screenings much simpler. However, they're not appropriate for everyone. Talk to your doctor. Depending on your family history and risk factors, he or she may recommend one over another.
A fecal occult blood test or fecal immunochemical test (FIT)
A FIT or fecal occult blood test is very simple. These tests can be an alternative to a colonoscopy, assuming you don't have other risk factors. They're done at home without special preparation, in the comfort of your own bathroom.
Using a kit, you collect a small amount of stool. It goes in a small tube or envelope that you'll send off to a laboratory by mail. The lab tests for small amounts of blood. Your doctor will receive the results. FIT and fecal occult blood tests differ only in the technology used to read the results. A positive test needs a colonoscopy as a follow-up.
A colonoscopy examines the entire colon. Colonoscopies include a consultation prior to your screening. Colonoscopy is more complicated than a FIT. You must drink a cleansing fluid to flush your colon the day before the procedure. Gentle sedation is often used (although some people may need anesthesia). You usually get the preliminary results right away, before you go home. Due to the lingering effects of anesthesia, you'll need someone to drive you home.
Your initial screening colonoscopy is covered in full even if polyps are found (whether benign or cancerous). Follow-up colonoscopies for those who have had a cancerous polyp are not considered screening colonoscopies.
There are several different types of colonoscopies:
Don't be on the hook for a colonoscopy or other colon cancer screening that's not covered! This procedure can cost more than $2,000. Be sure you know the date of your last screening before you schedule your 5-year follow-up.
Note: Your online claims are accessible via your secure Premera account for only 3 years. If you're unsure when your last screening was done, please call customer service at 800-508-4722.
If you have a strong family history of colon cancer, you may be covered for colonoscopy at an earlier age. You may also be covered for more frequent repeat screenings if you've had past tests that found precancerous growths. Contact customer service to determine what's covered.
Full anesthesia isn't always covered as part of your colonoscopy. Your doctor will determine what level of anesthesia is right for you to ensure you're as comfortable as possible.
Don't make the mistake of requesting "extra" or full anesthesia for a colonoscopy. This won't necessarily be covered, and you'll be responsible for this expense.
You can get coverage for over-the-counter, pre-colonoscopy laxatives (these may be referred to by your doctor or pharmacist as "cleansing preparations"). Your plan coverage is limited to 2 preparations every 365 days, and they require a written prescription from your doctor.
While colonoscopies certainly aren't pleasant, they can be life-saving. Talk with your doctor or Premera customer service if you have questions about when you should be screened. Sign in and use Find a Doctor to compare in-network costs for healthcare procedures including colonoscopies.
Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.
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