Colonoscopy and Sigmoidoscopy


Description

Colonoscopy: An outpatient procedure where a long, thin, flexible, lighted scope examines the entire large intestine (colon), from the lowest portion, the rectum, to the lower end of the small intestine.

Sigmoidoscopy: An outpatient procedure where a short, thin, flexible, lighted scope examines the lower third of the large intestine (colon).


What are the different reasons my doctor would order this procedure?
  • As a Routine Screening
  • To monitor or treat a known condition

Where do I find out how this will be covered with my benefit plan?

  • When performed as routine screening, the following benefits in your benefit document apply:
 Service     Section Benefit 
Physician surgical  Professional Services  Preventive, routine cancer screening
 Anesthesia Services     Professional Services  Preventive, routine cancer screening
 Outpatient hospital or surgical center  Professional Services  Preventive, routine cancer screening
 Pathology test  Professional Services  Lab/Pathology

 

  • If the colonoscopy is done to monitor or treat a known condition, the following benefits in your benefit document apply:

Service  Section Benefit 
Physician surgical  Professional Services  Surgical services received from a physician during an outpatient hospital or ambulatory surgical center visit
 Anesthesia Services  Professional Services  Anesthesia services received from a provider during an outpatient hospital or ambulatory surgical center visit
 Outpatient hospital or ambulatory surgical center  Hospital Services  Outpatient services, other outpatient services
 Pathology test      Professional Services  Lab/Pathology


Things to remember
  • Even if polyps are found and removed during the routine examination, the colonoscopy will still pay under preventive benefits as a routine cancer screening when the intent was a routine screening procedure.
  • If you have any further questions regarding your benefits, please contact Customer Service at the number on the back of your ID card.
Colorectal Cancer Screening Fact Sheet

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