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HMSA Member News > Member NewsWinter 2011 IS Magazine

Your First Colonoscopy

What to expect from the procedure – and your HMSA coverage.

By Sharon Yoshiura, Manager, Member Advocacy, HMSA

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 anesthesia.

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.

Island Scene Online is not intended to replace the advice of health care professionals. Please consult your physician for your personal needs and before making any changes in your lifestyle.
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