QUESTION

I went for a preventive screening colonoscopy and received a bill for the anesthesia used during my procedure as well as for the pathology exam to examine the polyp that the doctor found. Is this allowed?

Post enrollment issues | Individual Health Insurance
ANSWER

No, not under an ACA plan. Anesthesia must be covered without cost-sharing if your doctor determines that anesthesia services are medically appropriate for you. The pathology exam for the polyp biopsy must also be covered without cost-sharing because this is an integral part of the colonoscopy preventive screening to determine whether a polyp is malignant. Additionally, if your doctor determines that you need a pre-colonoscopy consultation to determine whether or not you are healthy enough to undergo the preventive colonoscopy, the consultation must be covered as well without cost-sharing. (CMS, Affordable Care Act Implementation FAQs – Set 26, May 11, 2015 and Affordable Care Act Implementation FAQs - Set 29, Oct. 23, 2015).

Individuals with no coverage
Individuals with coverage
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Post enrollment issues