question on cost of colonoscopy with medicare

@samdeman Do you have Medicare Advantage or Traditional Medicare? I have Traditional Medicare which means I have Medicare Part A, Medicare Part B is deducted from my Social Security each month, and I have a supplemental plan through TransAmerica that covers the "gap" of what Part B does not cover. I had colonoscopy last year at Mayo Clinic in Rochester and since I had already met my deductible for Medicare Part B for the year so I had no costs associated with my colonoscopy. It was paid for by Medicare Part B and my Supplemental Plan through Transamerica paid the remainder.

If you have a Medicare Advantage plan which is different do you know which insurance company you purchased the plan through? Was it United Health Care or perhaps Blue Cross Blue Shield? If you have Medicare Advantage then I suggest you call the number on the back of your Advantage card and ask the question about the cost for a colonscopy.

Does this help?

I also don’t have Advantage - just A, B, & D. plus gap supplemental
Coverage through Aetna. I had already met My less than $200 deductible and had no out of pocket costs.

I might ask for detail on why a diagnostic study is more than expensive than a screening study - if that turns out to be the case. And I would ask registration at the hospital why they didn’t notify you of the cost when you registered.

Calling you after the fact for a scheduled study is not typical my experience.

Suggest you always ask the provider for the code of the procedure and run that past insurance and/or Medicare prior to having the work done. It's easy and then no surprise. Happy for your result! BtW a positive Cologuard is indicative of cancer in only 5% of cases

in a way cologuard would benefit society most by giving everyone a false positive. it would influence people to have the colonoscopy, which i would not do otherwise.

wise remark on getting code.

I recently had a diagnostic colonoscopy. I have Medicare A & B with Tricare 4 Life as a supplement. My bill was paid in full between the two. Perhaps wait until Medicare receives the claim and processes it before worrying about the balance?

Your colonoscopy followed a positive Cologuard test so it might be considered diagnostic and not screening.
"A screening test is a test provided to a patient in the absence of signs or symptoms. A screening colonoscopy is a service performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. As part of the Affordable Care Act (ACA), Medicare and most third-party payors are required to cover services given an A or B rating by the U.S. Preventive Services Task Force (USPSTF) without a co-pay or deductible, but the correct CPT and ICD-10-CM codes must be submitted to trigger coverage at 100% for the patient."
"A Diagnostic colonoscopy is a test performed as a result of an abnormal finding, sign or symptom (such as abdominal pain, bleeding, diarrhea, etc.). Medicare and most commercial payors do not waive the co-pay and deductible when the intent of the visit is to perform a diagnostic colonoscopy."
https://gastro.org/practice-resources/reimbursement/coding/coding-faq-screening-colonoscopy/?gad_source=1&gclid=EAIaIQobChMItJfltMONhQMVaxCzAB2RQQquEAAYASAAEgKVQ_D_BwE

I have original Medicare with a Medigap policy. My first colonoscopy was under employer insurance and found polyps. I have had four colonoscopies since all under Medicare. Polyps were found each time, so they were "diagnostic". My Medigap insurance covered anything Medicare did not pay so I had no additional expenses. And I chose my doctor and location!

thank you for the thorough response.

i got a call from the hospital. they told me the cost of the procedure all in including anestheis was plus minus 6800. they said my end of the amount
owed was 2300.
i put 500 on my credit card and will pay the balance in the immediate months ahead.
i called medicare and asked them about it. they said my file was not ready for reveiw yet but will be in a couple weeks, i am to call back.

when i had my procedure i did notice there were alot of nurses , aides, and medical people milling around and assisting, so it is frankly not surprising whatever the cost is.

and i am thiankful that i am not diagosed with colon cancer.

my understanding of my cost was 15 per cent of the cost of the polyp removal.
beyond that i was not aware.

but in any event, i am budgeted for whatevever the fee is, am thankful that it is done, and while , at 72, i know something is going to end my life, sooner than i might wish, it is unlikely to be colon cancer.

best wishes.
sam