Colonoscopy Bill Prohibits Extra Charges for Removing Polyps

Kaiser Permanente, Health Net, Cigna and Regence BlueCross BlueShield had been among the insurers to charge fees, though Regence said the charges had been a mistake and now supports the bill.

A divided Senate Thursday found an election-year issue it can get behind -- free colonoscopies, even if a physician has to remove polyps during the screening.

Colonoscopies have already been a procedure that health insurance companies have had to cover without any additional copayments. But some companies have been adding additional diagnostic charges if any abnormal growths known as polyps are found and quickly removed.

“Some expecting to pay nothing could end up with thousands of dollars of unexpected medical expenses,” said sponsor Sen. Elizabeth Steiner Hayward, D-Portland.

House Bill 4085 prevents this diagnostic charge, giving people greater confidence that they can get checked for colon cancer without worrying about surprise bills from their health insurance company.

Sen. Alan Bates, D-Medford, said if serious cancer were found, additional surgery and  treatment would occur, but often the detected polyps are benign and easily removed during the course of a routine colonoscopy exam, which is recommended for anyone older than 50.

“Sometimes you find a polyp that is cancerous and can remove it and cure cancer,” Bates said.

Bates told The Lund Report that HB 4085 levels the playing field since many insurers do not charge extra for polyp removal. “I’ve had patients who refuse to get a colonoscopy screening. They say, ‘I can’t afford it,’” said Bates, an osteopathic family physician. “If you don’t get the screening, you don’t save the life.”

Steiner Hayward told The Lund Report she found it strange that insurance companies would even add charges to remove polyps during the screening process because ultimately it will save insurers more money as opposed to paying for cancer treatment.

“I don’t think patients should be subject to such games,” said Steiner Hayward, a family physician at Oregon Health & Science University. “It gives insurance companies a bad name.”

Steiner Hayward couldn’t say which insurance companies had tacked diagnostic fees onto colon screenings, and none of them testified against HB 4085 during the public hearing process, but testimony from Regence BlueCross BlueShield suggested that the problem lies not with the insurer but the physicians.

“We cover related lab tests and anesthesiology,” said Regence lobbyist John C. Powell at the House Health Committee hearing earlier this month. “The main problem is when the provider doesn’t know to code it as preventive procedure.”

Powell supported HB 4085, and said Regence already covers polyps removal  without an additional charge.

Kaiser Health News reported that Cigna, Kaiser Permanente, Health Net Health Plan and Regence had been among the insurers that charged for polyp removal, but Regence spokeswoman Rachelle Cunningham said that had been a mistake.

Both state law and the Affordable Care Act already disallow the charges, and the attention caused by HB 4085 should make clear to practitioners as well as insurers that polyps are included with the screenings.

The House passed the bill last week on a similarly unanimous vote. The colonoscopy bill now goes to the office of Gov. John Kitzhaber, M.D.

“I think this is a good bill, and we should put the issue behind us,” said Sen. Fred Girod, R-Stayton.

Chris can be reached at [email protected]
 
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