open access colonoscopy

Open Access Colonoscopy

The Open Access Program allows healthy, age-appropriate patients (those with no significant gastrointestinal symptoms) to have a colonoscopy performed without having to schedule a preop office visit.

What are the Open Access candidate qualifications?

Patients with strong family history of colon cancer.

Patients between the age of 50-74 and a weight below 350 lbs.

What are the Pros of the Open Access Program?

Receiving a potentially life-saving procedure and skipping the inconvenience of an initial office visit, therefore saving time and a co-pay.

For referring clinicians, this program encourages undecided patients to go ahead and schedule the procedure

How does the program work?

A referral form is completed and sent to CDD via the primary care provider. The form is then reviewed, and the Open Access clinical team will contact the patient to set up the procedure and an office visit (if deemed necessary).

Participation in the Open Access Program is contingent upon pre-procedure insurance approval and medical history.

Coverage of Colonoscopies Under Affordable Care Act: What You Need to Know!

The Affordable Care Act passed in March 2010 allowed for several preventative services, such as colonoscopies, to be covered at no cost to the patient. However, there are many caveats that prevent patients from taking advantage of this provision. One example is a “grandfather” clause, where insurance companies have two years before offering preventative services at no cost.

The ever-changing and strict guidelines for which colonoscopies can be defined as preventative may exclude many patients with gastrointestinal histories from taking advantage of the service at no cost, meaning patients would be required to pay deductibles and co-pays.

Below is some information that may alleviate the confusion many patients face when it comes to billing & insurance coverage for colonoscopies.

Colonoscopy Categories:

Diagnostic/therapeutic colonoscopy

Patient has past and/or present gastrointestinal symptoms, polyps, or gastrointestinal disease.

Surveillance! High Risk Screening Colonoscopy

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 are
required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years).

Preventive Colonoscopy Screening

Patient is asymptomatic (no gastrointestinal symptoms either past or present), over the age of
50, has no personal or family history of gastrointestinal disease, colon polyps, and/or cancer. The patient has not undergone a colonoscopy within the last 10 years. Your primary care physician may refer you for a “screening” colonoscopy, which typically is no cost to the patient. However, you may not qualify for the “screening” category, which will be determined in the pre-operative process. Before the procedure, you should know your colonoscopy category because based on that, a billing “code” will be applied to the procedure, therefore affecting your coverage and potential costs.