Are Colonoscopies Covered By Insurance?
10 Minutes
Team Curative
Apr 19, 2024
The Today Show recently reported on the story of 30-year-old Chris Lopez, whose severe stomach pains were initially misdiagnosed as food poisoning or a parasite. Yet after months of tests, doctors correctly identified the true cause of his symptoms, colon cancer — a huge mistake made in part because he was so young.
Colon cancer is, in fact, the number-one leading cause of cancer death in men under 50 and the number-two cause in younger women, behind breast cancer. Though the cause of this spike in younger cases is unclear, preventive health measures like colonoscopies can help with early detection.
Are you a prime candidate for preventive care screenings like this? We’ll discuss the trends surrounding colorectal cancer, what a colonoscopy is exactly and when you should get one, why colonoscopies are a critical element of preventive care, and how to avoid cost being a prohibitive factor in getting one. (Hint: Curative can help).
What is colorectal cancer?
Colorectal cancer is a type of cancer that starts in the colon or the rectum. These parts of the digestive system are part of the large intestine, which plays a vital role in the body's ability to process waste. Colorectal cancer often begins as small, noncancerous (benign) clumps of cells called polyps that form inside the colon or rectum. Over time, some of these polyps can become colorectal cancers.
What are the rates of colorectal cancer?
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third most common cause of cancer-related death in both men and women in the United States. However, it ranks second in cancer-related deaths overall and is the leading cause of cancer death in men younger than 50 years of age.
Yet, rates are on the rise among Millennials and Gen Z, and CRC incidence trends are rapidly shifting the patient population younger; 20% (1 in 5) of CRCs in 2019 were in people 54 years or younger, up from 11% (1 in 10) in 1995.
Incidence rates for advanced disease have increased by about 3% annually in people younger than 50 years of age, even though a large proportion of CRC incidence and mortality is preventable through the receipt of regular screening, surveillance, and high-quality treatment.
Why is there a rise in the incidence of colorectal cancer among younger people?
The exact causes of this increase in colorectal cancer numbers for young people are unknown, but several theories have been proposed. It's easy to point to genetics initially. Still, Dr. Vikram Reddy, who conducted one of the first studies on this generational rise nearly 15 years ago, notes, "Yale doctors are seeing a lot of young people whose colorectal cancer seems to be happening sporadically, as opposed to being caused by a particular genetic syndrome.” Lifestyle and environmental factors such as sedentariness, obesity, heavy alcohol use, low-fiber or high-fat diets, and diets high in processed meats have all been associated with the disease.
Despite preventive care being an option, the younger demographic has specific concerns when a diagnosis occurs. Generation Zers, Millennials, and Generation Xers, all of whom range in age from mid-20s to late-50s, may experience career interruptions and financial consequences due to diagnosis. Big life decisions might be accelerated when it comes to topics like fertility, as younger people consider preserving sperm or eggs in case treatment impacts their ability to conceive.
While the incidence in young people is rising, it’s still too low to justify routine, preventive health screenings like colonoscopies. However, new guidelines do encourage earlier screenings. In 2021, the U.S. Preventive Services Task Force updated its guidelines to lower the recommended starting age for colorectal cancer screening from 50 to 45, responding to rising rates among younger populations. Individuals with risk factors, such as a family history of early-onset colorectal cancer or conditions like inflammatory bowel disease, may need to begin screening even before age 45.
What is a colonoscopy, and can this preventive health measure prevent cancer?
Considered the “gold standard” of preventive care procedures, a colonoscopy examines the inner lining of the large intestine (colon) and rectum. Doctors can see it all using a long, flexible tube equipped with a tiny video camera at the tip, known as a colonoscope. While the preventive health procedure is primarily used for screening and diagnosis of colorectal cancer, it is also performed to investigate intestinal symptoms such as abdominal pain, rectal bleeding, or changes in bowel habits.
Most colorectal cancers begin as small, benign polyps that gradually become cancerous. By identifying and removing these precancerous polyps (or adenomas) early, a colonoscopy can effectively prevent the onset of colorectal cancer, making it a powerful tool in cancer prevention strategies. Colonoscopies identify approximately 95% of CRC, but it isn’t the only option. The medical industry has developed other preventive health screenings for CRC. Yet all of these tests prompt further tests if any abnormalities are found.
Fecal Immunochemical Test (FIT)
detects hidden blood in the stool, which can be a sign of cancer
non-invasive
performed annually
less sensitive than a colonoscopy
can produce false positives or negatives
Stool DNA Test
checks for specific DNA markers and blood in the stool that may indicate the presence of cancer or precancerous polyps
non-invasive
can be done at home
less accurate than a colonoscopy
more likely to result in false positives
Flexible Sigmoidoscopy
doctor uses a shorter, flexible tube to examine the rectum and the lower part of the colon
less invasive than a colonoscopy
does not usually require full sedation
only examines part of the colon and may miss cancers or polyps in the upper part
CT Colonography (Virtual Colonoscopy)
CT scanning produces images of the colon and rectum
less invasive
does not require sedation
if polyps or abnormalities are found, a traditional colonoscopy will still be needed to remove them
When should I get a colonoscopy?
The answer isn't entirely straightforward, as the timing for this preventive care screening can depend on several risk factors. Patients with normal risk are advised to schedule colonoscopies starting at age 45 and periodically through age 75. High-risk patients should be screened before age 45. You are considered high-risk if you:
Have a first-degree relative (e.g., parent or sibling) with a history of colorectal cancer
Are age 40 or 10 years younger than the age at which the family member was diagnosed, whichever is earlier
Have inflammatory bowel disease
Have inherited genetic changes, including Lynch syndrome and familial adenomatous polyposis (FAP)
Certain symptoms should also prompt you to seek screening. “Even if you're in your 20s or 30s,” Dr. Patel says, “you should get checked out if you have rectal bleeding, if you have any change in your bowel habits, any change in appetite (like feeling “full” early), weight loss, or abdominal pain that is not explained.” Other red flags could include:
A feeling that you need to have a bowel movement that is not relieved by having one
Blood in the stool, which might make it look dark brown or black
Weakness and fatigue
Colorectal cancer also disproportionately affects communities of color in the U.S.:
Black Americans are about 20% more likely to get CRC and about 40% more likely to die from it.
Indigenous communities have a higher incidence of CRC than their white counterparts.
Less than 50% of Asian Americans are up-to-date with colorectal cancer screening.
Why are colonoscopies a critical element of preventive care?
The CDC estimates that 68% of deaths from colorectal cancer could be avoided if all eligible people got screened. The good news? Because colonoscopies effectively detect and prevent cancer, the Affordable Care Act requires insurance providers to cover preventive health screenings starting at age 45. In addition, providers are required to cover follow-up colonoscopies for those over age 45 when necessary after home-administered screening tests.
Curative health plans cover preventive care like colonoscopies for its members, engaging with them from day one by facilitating trusted relationships with a Baseline Visit and Care Navigator. Members’ primary care providers and Care Navigators work to create a personalized preventive healthcare plan. Eligible members can access colonoscopy services covered by Curative by scheduling a baseline visit or visit with a Primary Care Physician (PCP).
At your appointment, discuss risk factors and symptoms with your provider. If you're over age 45, schedule your colonoscopy, and it's fully covered. If you’re under 45, don’t worry. When your PCP recommends getting a colon cancer screening, they can seek prior authorizations from Curative to proceed.
To see all disclaimers, please view here.
About Curative
Do you love using your health benefits? At Curative, we want you to! We bring better health to our members through affordability, engagement, and simplicity.
With one monthly premium, Curative members have access to all kinds of preventive care treatments, and you pay:
No copays
No out-of-pocket fees
No cost for preferred prescriptions
No deductibles for care within our network.
No…really. All that “nothing” certainly adds up to a lot. Curative is changing the way we view health insurance.
For more information on our health insurance, visit our members page.
References
ACS Medical Content and News Staff. (2021, February 8). Signs and symptoms of colon cancer. Signs and Symptoms of Colon Cancer | American Cancer Society. https://www.cancer.org/cancer/latest-news/signs-and-symptoms-of-colon-cancer.html
Cancer mortality still declining, but progress threatened by increasing incidence as projected new cancer cases top two million for 2024. American Cancer Society MediaRoom. (2024, January 17). https://pressroom.cancer.org/acs-cff-2024
Cancer Straight Talk from MSK. (2023, April 6). Katie Couric’s cancer journey: From grief to advocacy to her own breast cancer diagnosis. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/videos/katie-couric-cancer-journey-grief-advocacy-her-own-breast-cancer-diagnosis
Desai, N., & Rabinowitz, L. (2022, June 15). Colon cancer screening decisions: What’s the best option and when? Harvard Health.
Exact Sciences Corp. (2022, December 20). Medicare and insurance policy updates in 2023 will improve cancer screening access by removing patient colonoscopy cost following a positive cologuard test. PR Newswire: press release distribution, targeting, monitoring and marketing.
Follow-up Colonoscopy | Fight Colorectal Cancer. (2023, March).
Jones, V. (2023, June 6). Colorectal cancer screening: At what age should I get a colonoscopy?. MD Anderson Cancer Center. https://www.mdanderson.org/cancerwise/colorectal-cancer-screening--at-what-age-should-i-get-a-colonoscopy.h00-159619434.html#:~:text=Current%20guidelines%20suggest%20that%20you,from%20age%2045%20through%2075
Katella, K. (2024, January 17). Colorectal cancer: What Millennials and Gen Zers need to know. Yale Medicine.
Mayo Clinic Staff. (2022, May 18). Colonoscopy. Mayo Clinic.
https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569
Pasricha, T., & Friedman, L. S. (2022, October 18). How well do colonoscopies prevent colorectal cancer? What you need to know. Harvard Health.
Pawlowski, A. (2024, March 14). Chef, 30, was told his stomach pain was food poisoning or parasite. It was colon cancer. TODAY.com. https://www.today.com/health/men-s-health/chef-stomach-pain-colon-cancer-rcna143166
