New Insurance Guidance Benefits Patients

Many patients getting screened for colorectal cancer (CRC) soon will not have to pay out of pocket for a follow-up colonoscopy to evaluate a positive, non-invasive CRC-screening test.

New federal guidance released in January will soon require health insurance plans to fully cover the cost of a follow-up colonoscopy to evaluate a positive result from an MTs-DNA stool-based test (Cologuard) as well as a fecal immunochemical test (FIT).

“Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), told MedicalXpress.

It is important to understand that if your FIT or Cologuard test comes back positive for colon cancer, a follow-up colonoscopy is critical for your health. You are twice as likely to develop more advanced colon cancer if you skip this follow-up procedure.

In the past, cost has been a significant barrier to many people, making it a primary reason not to get the follow-up colonoscopy. This new follow-up screening coverage is for plan or policy years beginning on or after May 31, 2022. Patients need to check with their insurance provider about this coverage.

“This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs,” Anjee Davis, MPPA, president of Fight Colorectal Cancer told MedicalXpress. “Ultimately, this will save lives and support early detection of colorectal cancer.”

45 Is the New 50 for Colon Cancer Screening

Leading health organizations now recommend CRC screening starting at age 45, not 50, for all average-risk individuals due to an increase in the disease in younger people.

In 2020, the American Cancer Society (ACS) reported about 12 percent of all cases of CRC occurred in individuals younger than 50. Patients diagnosed prior to age 50 were more likely to have advanced disease at diagnosis.

Colorectal cancer is the second leading cause of cancer death in the U.S. and one of the most preventable through timely screenings. About 60 percent of all colon cancer fatalities in the United States could be prevented if every man and woman 45 or older chose to be screened for colon cancer, according to the ACS.

“This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer and more than 52,000 will die from the disease,” Lacasse told MedicalXpress. “But colorectal cancer is preventable when precancerous polyps are found and removed through a colonoscopy.”

Many screening methods are available for CRC, but a colonoscopy is the gold standard because it is the only screening that can both detect and prevent colon cancer.

According to a 2019 online survey, “colonoscopy was the most frequently preferred option for average-risk patients, favored by 96.9% of gastroenterologists and 75.7% of primary care clinicians.”

Prioritize Your Colon Cancer Screening

If you are 45 or older, prioritize your colon cancer screening. The five-year survival rate is about 90 percent when CRC is found at an early stage before it has spread.

Screenings save lives. Don’t delay your diagnosis. Don’t delay your colonoscopy. Call your gastroenterologist today.