Is a colonoscopy covered by my health insurance plan? Is it a preventative care benefit?

Many people are aware that preventative care is now covered with no cost sharing (this is insurance-speak for “FREE”) on all health insurance plans purchased after the PPACA (the “health reform act” or “Obamacare,” depending on your politics) went into effect in the spring of 2010. And most people understand that this includes an annual physical, an annual OBGYN visit for women, vaccines for kids, and mammograms for women over 40. But what about a colonoscopy?
It comes up a lot because it’s something that people of a certain age need to do, and it is seriously expensive. Like over $2,000.
While there’s a temptation to crack jokes, the question is legit. Is a colonoscopy paid for by your insurance as part of preventative care? The answer is yes, BUTT (my inner-7th grader can’t help that…) there is an important qualifier. With most insurance companies, if a screening turns into something more diagnostic or corrective, you could be liable for a lot of the charges.
In other words, if something (like a polyp) is found and removed, you could wind up paying for it because the procedure is no longer considered preventative. The key to this (in fact, the key to so much of any insurance claim) is the medical coding — how that procedure is coded by the medical provider’s office and submitted to the insurance company.
The bottom line (there I go again), is that if you’re over 50 you need to get this done. If nothing is found, you shouldn’t have to pay for it. If something is found, it’ll be worth the money you wind up paying to get it taken care of, and it will count towards your deductible for the year too.