Colonoscopy Time? Here’s What You Need to Know Before You Go!

(Yes, the jokes are endless, but we’re here to give you the facts!)

If you’re prepping for a colonoscopy, it’s wise to be informed about the insurance side of things before scheduling your appointment. Knowing what to expect can help you avoid surprises and even save you money. Here’s a quick guide:

Make Sure You Have Your Referral In Hand Before Scheduling

1. Got an HMO? First, Get a Referral

If you have an HMO plan, you’ll need a referral to see a gastroenterologist for your colonoscopy. Keep in mind:

• Tip: Your referring physician might not check if the gastroenterologist is in-network with your insurance. This is crucial because out-of-network visits can lead to higher costs.

How to Check Network Status:

• Option 1: Search for the gastroenterologist in your insurance provider’s online directory.
• Option 2: Call the gastroenterologist’s billing department (not the front desk!) to confirm they accept your insurance.

Once you’re sure they’re in-network, you’re ready to schedule your visit!

Know Your Visit Type: Preventive Or Follow-Up—It Makes A Difference!

2. Confirm the Visit Type: Preventive or Follow-Up?

When scheduling, clarify if this is a preventive visit or a follow-up. Why does this matter?

• With ACA plans, preventive care is often covered 100%, meaning you may have no out-of-pocket costs.
• Important Note: The front desk might request payment based on your plan's general rules. If your visit is preventive, let them know that it should be covered and request to be billed later if needed.

Confirm That The Anesthesiologist Is Also In-Network

3. Don’t Forget the Anesthesiologist!

Your procedure will likely involve an anesthesiologist, but here’s a common pitfall:

• Anesthesiologists often operate separately from the facility performing your colonoscopy. If they’re out-of-network, you might get a separate bill for their services.

• Ask for the Anesthesiologist’s Name before the procedure.
• Confirm Network Status: Call the anesthesiologist's office directly and check if they are in your insurance network or billed through the facility.

At My Health Aviator, we empower you to make informed choices so you can focus on what truly matters—your health.