We hope that this article published by Kaiser Health News helps you understand how insurers must cover colon and rectal cancer screenings.

Questions About Colon Screening Coverage Still Vex Consumers
By MICHELLE ANDREWS
APR 16, 2013

No one looks forward to screening tests for colon and rectal cancers. But under the Affordable Care Act, patients are at least supposed to save on out of-pocket costs for them. Coverage is not always clear, however, and despite the federal government’s clarifications, some consumers remain vexed and confused.

Under the law, most health plans are required to cover a range of preventive health services without any cost-sharing by patients if they’re recommended by the U.S. Preventive Services Task Force, an independent group of medical experts. (The only exception is for health plans that have grandfathered status under the law.)

Colorectal cancer is the second leading cause of cancer death in the United States. Screening can catch cancers earlier, and removing polyps discovered during a colonoscopy can prevent cancer from developing in the first place.

The task force recommends colorectal cancer screening for most adults starting at age 50. These tests include colonoscopy (in which a doctor inserts a flexible tube with a video camera at the end into the anus to examine the large intestine for polyps, tumors and other abnormalities), sigmoidoscopy (a similar process that examines only the lower part of the colon) and fecal occult blood testing (which examines the stool for traces of blood).

A colonoscopy is the most thorough of the screening tests and is favored by many clinicians. But about half the time, polyps are discovered and removed during the test to determine whether they are cancerous. This can create billing problems for patients, says Katie Keith, a research professor at Georgetown University who co-authored a report on screening colonoscopy coverage under the Affordable Care Act.

According to the study, some insurers judged that a colonoscopy with polyp removal was a therapeutic rather than a screening procedure, and subsequently billed patients for some or all of the test’s cost, depending on their coverage, which can reach $2,000, sometimes more.

In February, the Obama administration stated that for people in group and individual health plans, polyp removal during a screening colonoscopy was an integral part of the screening test and should be covered without patient cost sharing.

The guidance doesn’t apply to Medicare beneficiaries, however, who may still face a co-payment if a polyp is discovered.

Other screening coverage questions remain murky. What happens, for example, if someone gets a positive result on a fecal occult blood test? In that case, the task force says a colonoscopy is required to examine the colon for polyps or other problems. But insurers vary in whether they consider such a follow-up colonoscopy to be part of the original screening process or a separate diagnostic test, according to the report by Keith and others, including the Kaiser Family Foundation. (Kaiser Health News is an editorially independent project of KFF.)

“In many communities, stool testing may be common because people can’t get an appointment for a colonoscopy for months,” says Robert Smith, senior director of cancer screening at the American Cancer Society, another co-author of the report. “If they have a positive stool test, now they face the uncertainty of what it would cost to get the colonoscopy.”

Another gray area emerges when people are at higher risk for colon cancer because of family history or their own history of polyps. In these cases, patients are often advised to get a colonoscopy more often than every 10 years, the recommended frequency for people at average risk. In February, the federal government clarified that high-risk patients could qualify for more frequent screening without cost sharing.

Despite this, some patients have run into coverage snags.

Because doctors discovered three polyps during a colonoscopy five years ago, Allen Worob, 66, is considered at high risk for colon cancer. Worob’s physician advised him to get another colonoscopy in five years. At first, Worob’s insurer told him that the procedure would cost him nothing if no polyps were found but that he’d owe the full $2,500 charge if a polyp was discovered. (Worob’s primary coverage is through his wife’s group health plan, supplemented by Medicare.)

After more discussions with his insurer, Worob, who lives in Rochester, N.Y., was told the procedure would be covered without any out-of-pocket charge whether or not any polyps were found. But Worob didn’t want to take any chances. He decided to wait for a letter from his insurer spelling that out before getting the test.

“Just because [the goveernment] has clarified the law, it doesn’t mean anybody’s going to follow it,” he says. “I can’t take a $2,500 hit.”

Despite the administration’s explanations, questions remain, says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group.

“The [Department of Health and Human Services] has issued clarifications on some scenarios related to colonoscopy screening, but other questions are being raised and we may need to ask for further clarification,” she says.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

It’s the screening test no one really looks forward to, but a colonoscopy is one of the few tests that can prevent cancer.

“Colon cancer is almost 100 percent curable if found in its early stages,” said Dr. Aristotle Damianos, a gastroenterologist at Portsmouth Regional Hospital. “A colonoscopy is the most accurate test there is for looking at the entire colon.”

Colon cancer is the second leading cause of cancer deaths in the United States, affecting 1 in 20 adults. The American Cancer Society estimates 142,820 people will be diagnosed in 2013 and that 50,830 will die from colon cancer in the United States.
Colon cancer, when discovered early, is highly treatable. Screening detects pre-cancerous polyps and allows them to be removed during the colonoscopy before they become cancerous. Screening also helps find colon cancer at an early stage, when treatment often leads to a cure.

Most colon cancers develop first as colorectal polyps, which are abnormal growths inside the colon or rectum that may later become cancerous.
Colonoscopies are recommended for everyone over the age of 50.

Certain other high-risk groups may undergo screening colonoscopy at an earlier age. High-risk groups include people with a family history of colon cancer, prior history of polyps or a history of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease.

“If there is a family history of colon cancer, the patient’s primary care physician may recommend a colonoscopy for the patient when he or she is 10 years younger than the age when the relative was diagnosed with colon cancer, or at age 40, whichever comes first,” Damianos said.

Colonoscopy is also often recommended to investigate specific symptoms such as blood in the stool, diarrhea, anemia, or to follow up on an abnormal X-ray.
Portsmouth Regional Hospital is again offering free colonoscopies for three Saturdays in March for clients of Families First Health and Support Center in Portsmouth.

“This is our third year partnering with them,” Damianos said. “Last year, we screened 32 patients and found precancerous polyps in 25 percent of them that we removed.”
Two patients were found to have cancer.

“One was cured,” Damianos said. “And one went on to have surgery.”

Beginning in 2014, polyp removal should be a covered procedure during a colonoscopy in a provision of the Patient Protection and Affordable Care Act that requires coverage of preventive care, including screening colonoscopies, by insured and self-funded health benefit plans with no out-of-pocket cost to patients.

“This is good news for us,” said Dr. Brain Hyett, a gastroenterologist who practices at Portsmouth Regional Hospital and York Hospital in York, Maine. “We may get more patients to come in for screenings.”

Hyett said colon cancer is a “silent disease,” and colonoscopies can “absolutely save lives.”

Colonoscopies are performed as a day procedure in the endoscopy unit of the hospital. They are usually done under conscious sedation, but may be done by general anesthesia depending on the individual patient’s health history.

While there is a virtual colonoscopy that can be done in radiology, if polyps are detected, the scope procedure must be done to remove the polyps. The preparation is the same for both tests.
While most patients say the test is a breeze, it’s the preparation the night before that makes the experience seem unpleasant. It usually consists of drinking a special preparation to clean out the colon. A clear liquid diet is also ordered for 24 hours prior to the test. Patients are asked not to drink anything with red coloring that may look like blood during the test.

“There are a variety of preparations,” said Erin McCarthy, clinical coordinator of endoscopy at Portsmouth Regional Hospital. “We take into consideration the patient’s age and underlying medical issues. Most do very well.”

Damianos said the volume of preparation fluid the patient has to drink is half of what it was 10 years ago and that some can take it in a pill form.
Jane May, leader of surgical patient care at York Hospital, said depending on the time the procedure is scheduled, the patient may begin the preparation in the middle of the night.
Since March is National Colorectal Cancer Awareness Month, York Hospital is offering an open house on Wednesday, March 20, from 4 to 6 p.m. in the special procedures area of the hospital’s new surgery center.

At 7 p.m. on Thursday, April 4, Dr. Damianos will offer a free community lecture at Portsmouth Regional Hospital called “Inflammatory Bowel Disease: Crohn’s & Ulcerative Colitis.” Register online at www.portsmouthhospital.com/calendar or call Consult-A-Nurse at (888) 421-1080.

The above is an exert from a [email protected] article by Suzanne Laurent click the link for the original story.

http://www.seacoastonline.com/articles/20130310-LIFE-303100314

In recognition that colorectal screenings save lives, the Affordable Care Act now requires all new health plans to cover the entire cost of screening colonoscopies, with no co-pay, for people over the age of 50.  This includes colonoscopy, sigmoidoscopy, or fecal occult blood tests. Most health plans will also cover the removal of polyps found during screenings.

Colorectal cancer is one of the most common cancers in men and women each year, with an estimated 143,000 diagnosed and more than 52,000 deaths in 2012. While some people find colorectal screenings unpleasant, a study published in the New England Journal of Medicine in February 2012 confirms that screening colonoscopies prevent deaths.

Talk to your doctor to decide what screening test is best for you. The physicians at Atlantic Digestive Specialists have been performing colorectal cancer screenings for more than 30 years, and have helped prevent colon cancer in countless patients. If you would like to schedule a screening colonoscopy exam, or have questions, please call any of our three offices in Portsmouth, Somersworth, and Hampton, NH at 603-692-2228and we will be happy to assist you.

“If everyone got regular colonoscopies, then no one would die of colon cancer” begins an article in the Boston Globe written by Joan Wickersham. To read the full story about colonoscopy screenings, click this link “A needed test that no one wants to get”.

The Centers for Disease Control and Prevention (CDC) now recommends that all baby boomers (born between 1945 and 1965) get a one-time blood test for the hepatitis C virus (HCV) to protect against liver disease and possibly death.

One in 30 people born between 1945 and 1965 has been infected with hepatitis C. Most of these people are unaware that they even have the virus.

“Because there are often no symptoms, a person can silently carry the virus for years,” says Dr. Aristotle Damianos, of Atlantic Digestive Specialists in Portsmouth, NH. “While the majority of people with hepatitis C will never get significant liver disease, about 30% will develop permanent scarring or cirrhosis of the liver, and a small fraction may go on to develop liver cancer. New drug therapies have made cure possible now for most infected patients.”

HCV is a spread through direct contact with infected blood. Common risk factors include blood transfusion prior to 1992, body piercings or tattoos, and intravenous or intranasal illicit drug use. Household transmission is extremely rare. Exposure to the virus can be detected with a blood test.

Talk to your doctor about having this simple blood test. The physicians of Atlantic Digestive Specialists have been treating and curing patients with HCV for over 25 years. New patients are being accepted at our Portsmouth, Somersworth, and Hampton, NH offices.

The physicians at Atlantic Digestive Specialists have been recognized by US News & World Report for the services they provide at Wentworth-Douglass Hospital (WDH).

The recently published report ranks the best hospitals in the country and cites that the gastroenterology specialists at WDH have performed nearly “at the level of nationally ranked best hospitals”. This places Atlantic Digestive Specialists in a higher category than a number of the gastroenterology practices at major Boston medical centers.

“We are very proud to be part of the success Wentworth-Douglass Hospital is experiencing,” says Dr. David Flavin of Atlantic Digestive Specialists. “Our practice is dedicated to advancing GI services and delivering superior medical care to the patients we serve in seacoast New Hampshire. It is rewarding to see the achievements of our team and those we work with at the hospital recognized on a national level.”

Atlantic Digestive Specialists earned the ranking for providing the highest level of key patient services available in this specialty including technology, survival scores, medical/surgical services, and reputation.

Atlantic Digestive Specialists is the largest private gastroenterology practice in Northern New England, and provides comprehensive digestive, liver, and intestinal services at Frisbie Memorial, Portsmouth Regional, Wentworth-Douglass, and York Hospitals. GASPA has offices in Somersworth and Portsmouth, NH.