Groups Come Together to Remind Oregonians it's Colorectal Cancer Awareness Month

A search resulted in a website that developed a map, grading states for their colorectal screening legislation. Oregon received an "A" for "...exceptional colorectal cancer legislation. Oregon requires insurance providers to cover preventative colorectal screening for all policy holders over the age of 50." The key word in the sentence above is "preventative." Health providers and doctors have established a loophole to covering the procedure. Doctors generally code a basic screening as preventative, but if they find anything (polyp, hemmorhoid, diverticulosis) - which is likely in most cases: 95% of the population have internal hemorrhoids and the majority over 50 have diverticulosis - that portion is coded "diagnostic". At a minimum, this means policyholders have to cost share, but for many policyholders, this means their insurance provider pays for nothing (our provider, United Health Care states that if anything is coded diagnostic, they consider the entire procedure diagnostic). The first key question is, how do insurance providers get to decide the entire procedure is considered diagnostic even part of the claim is coded preventative? How is this not challengeable? The second question is, what do hemmorhoids and diverticulosis have to do with cancer risk? (Answer: Nothing.) So then, why is an individual labeled "high risk" for all subsequent procedures which are also now considered diagnostic if either of these non-cancer risk things are found? Third: what is preventative if not screening for cancer, finding a polyp and removing it? Isn't that precisely why we have these procedures? To call identification/removal of a polyp "treatment" therefore not preventative and not covered by insurance providers, is just voodoo healthcare. The upshot is consumers such as myself, who have put this procedure off for 10 years (and made a sudden priority due to a friend's recent death of colon cancer), will further postpone it because...we can't absorb a $3800 bill (going rate in Oregon if they find something). We already experienced the murky waters of non-coverage in Oregon when my husband went for his second colonoscopy. His first procedure was covered 100%. We still had United Healthcare, but different plan. This was also at the time the federal law was adopted, which seemed like a good thing at first blush. Turns out it has it's own loophole, grandfathering in health plans in existence prior to its adoption. Like many federal laws, it shifted the burden to states to pick up the slack and we know how well Oregon's done with that. Going into his second colonoscopy, we were assured our health provider would pay for it, even though a single polyp was found in his first procedure. The nurse during the consult confirmed it would be covered, knowing his first one found a polyp. Imagine how happy we were to get a bill for $2200. Insurance company pointed to how the facility coded it (all as diagnostic) saying they couldn't control how facilities code things. The facility said they would not redo the coding, so we were stuck. And filing a dispute was pointless. We read about so many cases where policyholders in Oregon tried but failed in this exercise. A Portland-area clinic told me they used to code the entire procedure as preventative, even if something was found, but based on the ensuing debate over colorectal screening coverage in Oregon, they changed to coding the basic screening as preventative, polyp or other findings as diagnostic - all to 'fly under the radar' because they didn't want to risk being out in front if and when the issue was settled. In the end, the only ones who get insurance coverage in Oregon are those very few whose colonoscopies detect nothing AND the facility codes it as preventative. It is time for Oregonians to raise their voices in Salem to unmuddy the waters and reclaim complete coverage for this life saving procedure.