Know Your Insurance Coverage and Requirements Colonoscopy



Contact your insurance company. Let the customer service rep know you are having a colonoscopy and the reason for the procedure. Make sure you understand all the answers to your questions. Please let this office know if there is an issue with your colonoscopy coverage. If your insurance company denies benefits to cover your colonoscopy this office can work out a monthly payment plan. The hospital will bill you separately so you may need to discuss those finances with the hospital patient accounts department.


I AM ___YEARS OLD AND AM HAVING A SCREENING/ROUTINE/SURVAILLENCE COLONOSCOPY (different insurances use different terminology)


__: Not experiencing any specific GI medical problems

__: No problems but hava a personal history of colon cancer

__: No problems but have a personal history of colon polyp

__: No problems but have a family history of colon cancer (Father, Mother Sibling, Child)

__: No problems but have a family history of colon polyp (Father, Mother Sibling, Child)



__: I am experiencing GI medical problems such as

__: Rectal bleeding

__: Constipation

__: Diarrhea

__: Anemia

__: Abdominal pain

__: Other______________________________


What does my insurance policy cover? Will I have a deductible or balance due?

__: Screening according to the ACS with no symptoms: __Yes __No

__: Screening according ACS with a personal or family history: _Yes __No

__: Diagnositic colonoscopy because of GI problems: __Yes __No

__: Deductible or balance due after insurance payment __Yes __No



ATTENTION ALL UNITEDHEALTHCARE SUBSCRIBERS:  If you have a United Health Care Plan you may require an insurance authorization or insurance approval for your colonoscopy.  Your insurance may also direct you to the facility where your policy will cover your procedure regardless of your physician affiliation or your choice of facility.   Call your customer service dept. (phone number should be on the back of your insurance card. Tell the representative you are having a colonoscopy that will be billed using CPT code 45378 or 45380 or 45385 (depending upon findings at the time of your colonoscopy) and ask if your policy requires a UnitedHealthCare insurance prior authorization.  Also tell the representative the facility where your procedure is scheduled(Dr. Curran does procedures at Charles River Endoscopy Center which is a free standing ambulatory center or UMass Marlboro Hospital Outpatient Endoscopy Center or Marlboro Hospital Outpatient both hospital based facility.) Please then contact Doreen  at my office with the customer rep responses as your appointment will need documentation that an authorization for the procedure and place of service is or is not required. If authorization required, Doreen will then contact your insurance for the authorization necessary to confirm the date and place of your appointment and to submit a claim for your colonoscopy.








All patients who have contacted their specific customer rep dept. should document the following information that will be valuable if there are any future issues.




Date & Time of call & Customer Service Rep name_______________________________________