When you reach the milestone age of 50, your doctor may recommend a screening colonoscopy.
Some people may need one earlier, depending on their family history and risk factors.
If it’s time for your first colonoscopy, you’ll probably have questions.
What is a colonoscopy? Will my HMSA plan cover it?
A screening colonoscopy involves checking your colon (large intestine) for polyps,
sores or swelling. A colonoscopy doesn’t require an incision, and the surgery
is usually performed by a gastroenterologist or surgeon in an outpatient surgical
center or the doctor’s office. During the procedure, the doctor uses a colonoscope,
a thin, flexible tube fitted with a small camera, to check your colon.
A screening colonoscopy is a covered benefit of most HMSA plans for men and women
age 50 and older:
- Preferred Provider Plan members should use a participating provider
for maximum plan benefits.
- Health Plan Hawaii members must have a referral from their personal
care provider for services within their health center or health center network,
or from an HMSA participating gastroenterologist.
During the procedure, most people will need to be sedated; people at high risk may
need anesthesia. According to the American Gastroenterological Association, the
standard of care is to perform uncomplicated colonoscopies with sedation. High-risk
conditions that may require anesthesia during the procedure include chronic obstructive
pulmonary disease, uncontrolled seizure disorder, clinically significant valvular
heart disease, congestive heart failure, and extreme anxiety for which they are
being treated and/or taking medication. If you are at high risk and anesthesia is
medically necessary for you, it will be covered by your HMSA plan.
If the doctor performing the procedure tells you that you will have anesthesia,
ask if it’s necessary and what the risks are. The doctor and the anesthesiologist
or certified registered nurse anesthetist are aware that HMSA will not cover the
anesthesia without documentation of high-risk conditions and may inform you of a
“special rate” if HMSA does not cover your anesthesia. This special
rate should be discussed with you well in advance, and you may be asked to sign
an agreement to accept financial responsibility for the anesthesia.
The doctor should not inform you about the anesthesia and have you sign the agreement
on the day of your procedure. If this happens, the doctor cannot bill you for the
If polyps are found during the colonoscopy, they can usually be removed during the
procedure and sent to a laboratory for a biopsy. The laboratory will file a claim
with HMSA and your regular laboratory benefits will apply.
If you don’t have any polyps, you won’t need another screening colonoscopy
for 10 years. If polyps or questionable lesions are found, you may need a repeat
colonoscopy sooner. Finding small noncancerous polyps could still mean your colonoscopy
was normal, and a repeat colonoscopy will be covered in 10 years. If the polyps
are cancerous or precancerous, you will need a repeat diagnostic colonoscopy more
often, depending on the size and number of polyps found.