Aetna, Cigna, and United have recently updated all policies to cover colonoscopies as a colorectal cancer screening for average-risk members aged 45 years and older when recommended as medically necessary by a physician.
The American Cancer Society has come out with their recommendation to lower the age limit to 45 since studies show rates of colorectal cancer among people younger than 50 are on the rise.
When preventative care is deemed medically necessary, it’s usually covered at no cost, meaning patients don’t have to worry about copays, deductibles or coinsurance.
Under the revised policy, Aetna, Cigna and United consider any of the following colorectal cancer screening tests medically necessary preventive services:
- Annual immunohistochemical or guaiac-based FOBT; or
- Colonoscopy (considered medically necessary every 10 years for persons at average risk); or
- CT Colonography (virtual colonoscopy) (considered medically necessary every 5 years) (see CPB 0535 – Virtual Gastrointestinal Endoscopy); or
- Double-contrast barium enema (DCBE) (considered medically necessary every 5 years for persons at average risk); or
- Sigmoidoscopy (considered medically necessary every 5 years for persons at average risk)
- Sigmoidoscopy (every five years) with annual immunohistochemical or guaiac-based fecal occult blood testing (FOBT); or
- Stool DNA (FIT-DNA, Cologuard) (considered medically necessary every 3 years).
Interested in learning more? Contact our office and we’ll help you confirm your coverage benefits.