Getting Insurance to Pay for Screening Procedures

Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
My family is being followed by two universities for Hereditary Non-polyposis Colon Cancer (Lynch Syndrome II). My insurance will not pay for the screening colonoscopies that are recommended yearly. They say without symptoms, it is merely a screening procedure. I say it is early detection surveillance. I have appealed at several levels—sent supporting letters, one from Dr. Lynch himself. The insurance Commission says that because my company is self insuring, they have no control over them. I do not know how to proceed—this is an $800 procedure. Suggestions would be helpful, thanks.


Answer
We suggest that you inform your physician that you have exhausted every reasonable effort to receive coverage for the colonoscopy. He or she may be able to determine if funds can be made available through the university(s) to support ongoing research projects. They may also be able to petition the university to determine if the billing entities involved would consider either discounting their fees or providing the service "gratis". In addition, if you are participating in an ongoing research project, there may be funding available through the agency sponsoring the research to pay for the test.cancer.



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