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Urge Correction of Medicare Beneficiary Cost Sharing for Screening Colonoscopy

Passage of the Affordable Care Act marked a major victory in the fight against cancer. The law waives the coinsurance and deductible for many cancer screening tests, including colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT), which screen for colorectal cancer. However, due to the unique nature of screening colonoscopies, many patients wind up paying out of pocket. Please urge your member of Congress to correct this “cost sharing” problem by passing H.R. 1017/ S. 479, the Removing Barriers to Colorectal Cancer Screening Act.

Colonoscopy is a unique screening test because gastroenterologists are able to remove precancerous polyps and small cancers during the screening procedure. Under Medicare coding rules, removal of any polyp reclassifies the screening as a therapeutic procedure for which patients must pay coinsurance. This means a patient can go to the gastroenterologist for a colonoscopy assuming it’s free, only to receive a bill for the coinsurance after the doctor finds and removes a suspicious polyp.

Cost sharing creates financial barriers, which discourage the use of recommended preventive services. This could have a major impact on colorectal cancer screening since more than one third of U.S. adults age 50 and older have never been screened.

Bottom line: Colorectal cancer can be prevented through screening, and colonoscopy is the most cost-effective screening test for prevention. Patients should be incentivized, through the elimination of cost sharing, to use colonoscopy as a colorectal cancer screening mechanism. Additionally, the preventive screening benefit has contributed to the decline in colorectal cancer rates in our country and this benefit should be preserved in any health care reform legislation.

Please urge your member of Congress to support H.R. 1017/ S. 479, the Removing Barriers to Colorectal Cancer Screening Act, legislation that would waive the coinsurance for Medicare beneficiaries who have a screening colonoscopy that turns therapeutic.

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