Accepted Insurance Plans
Aetna
BlueCrossBlueShield of Michigan
Blue Care Network
Cofinity
HAP
Medicaid
Medicare
Priority Health
United HealthCare
Aetna Choice POS II (Aetna HealthFund & Open Access)
Aetna Open Access Elect ChoiceEPO (Aetna HealthFund)
Aetna Open Access Managed ChoicePOS (Aetna HealthFund)
Aetna Select
Aetna Select (Open Access)
Aetna Senior Supplemental
Aetna Elect Choice EPO
Aetna Elect Choice EPO (Open Access)
Aetna Managed Choice POS
Aetna Managed Choice (Open Access)
Aetna Open Choice PPO
Aetna Medicare Advantage
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BCBSM Traditional, Trust, PPO, & Federal
BCBSM Blue Preferred Plus
BCBSM Blue Choice
BCBSM Community Blue
Medicare Plus Blue PPO
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BCN (Blue Care Network)
BCN Advantage
BCN - U of M Premier Care
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Cofinity TPAs, including:
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HAP – Alliance Health & Life
HAP – Alliance Medicare PPO
HAP – HMO, PPO, POS, EPA, EPO
HAP – Self Funded HMO/POS Henry Ford Health System
HAP Preferred
HAP Preferred TPA Cigna
HAP Senior Plus HMO-POS
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Medicaid
Medicaid – Meridian
Medicaid – Molina
Blue Cross Complete
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Medicare
Medicare Railroad
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Priority Health HMO, PPO, &POS
Priority Health Medicare
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UHC - United HealthCare
UHC – AARP
UHC - Choice Plus POS
UHC – Choice EPO, HMO, & POS
UHC – Golden Rule
UHC – Oxford
UHC – PPO
UHC – Select EPO, HMO, POS
UHC – Navigate EPO & HMO
UMR
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We would like to help you better understand the terms your physician or your insurance company may use for a colonoscopy procedure and how it associates with payment methods.
“Screening” and “surveillance” are two terms that often cause confusion and can have different reimbursement outcomes. Even though your physician may order a “screening” colonoscopy, your insurance company may consider it a “surveillance” colonoscopy. If your insurance company processes the charge as a surveillance procedure, you may have some out-of-pocket expenses you did not anticipate. For this reason, we encourage all patients to contact their insurance company prior to their procedure. In order to help you better understand some of the possible cost sharing that may occur and to assist you during your call with the insurance company, we have included some information below regarding “screening”, “surveillance”, and diagnostic/therapeutic colonoscopies.
Payers Have Three Colonoscopy Categories:
SCREENING COLONOSCOPY
G0121 (CPT) Routine Screening Colonoscopy
Z12.11 (Diagnosis Code) Screening of the Colon
Definition: A screening colonoscopy is performed once every 10 years for asymptomatic patients over age 50 with no history of colon cancer, polyp, and/or gastrointestinal disease.
SURVEILLANCE COLONOSCOPY
G0105 (CPT) High Risk Colonoscopy
Z86.010 Personal History of Polyps
Z80.0 Family History of Colon Cancer
Definition: The patient is asymptomatic (no gastrointestinal symptoms either past or present),
has a personal history of gastrointestinal disease, colon polyps, and/or cancer.
Patients in this category typically are required to undergo colonoscopy every 2 – 5 years.
Depending upon on your insurance carrier, surveillance colonoscopy could be processed under your screening benefits or diagnostic benefit and may have some cost share.
DIAGNOSTIC / THERAPEUTIC COLONOSCOPY
45378, 45380, 45385, G0105 (typically)
Definition: The patient has past/or present gastrointestinal symptom(s), polyps,
or gastrointestinal disease.
In the event an abnormality is seen or suspected during the procedure, a portion of tissue (biopsy) may be removed or small growths (polyps), if seen, may be removed. Depending on your insurance coverage, this could be processed under your screening benefits or diagnostic benefit and may have cost share. Diagnostic procedures typically will have a cost share depending on your deductible obligation per your insurance plan.
In the event an abnormality is seen or suspected during the procedure, a portion of tissue (biopsy) may be removed or small growths (polyps), if seen, may be removed. Depending on your insurance coverage, this could be processed under your screening benefits or diagnostic benefit and may have cost share.
You may receive bills from separate entities associated with your procedure such as the facility, anesthesiology, pathology, and/or laboratory. If your procedure is scheduled at Center for Digestive Care, we can only provide you information based on our fees (professional, anesthesia, and facility), not ancillary fees such as pathology.
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