Follow-Up Tests to Preventative Screenings Can Bring Big Bills to Consumers

By Consumers for Quality Care, on June 29, 2022

While many preventative services like breast and colorectal cancer screenings are covered at no cost, patients may be responsible for up to thousands of dollars for diagnostic services if a provider orders more testing, according to Global Circulate.

Many medical experts and patient advocates say no-cost coverage should be extended beyond initial preventative testing to biopsies, imaging, and other diagnostic services.

“The billing distinction between screening and diagnostic testing is a technical one,” said Dr. A. Mark Fendrick of the University of Michigan. “The federal government should clarify that commercial plans and Medicare should fully cover all the required steps to diagnose cancer or another problem, not just the first screening test.”

According to federal rules recently adopted, follow-up tests for commercially insured people in need of colonoscopies are considered an integrative part of the preventive screening, and patients can no longer be charged by their health plan. Nine states already required similar coverage in the plans they regulate for follow-up colonoscopies.

CQC urges lawmakers and regulators to ensure both preventative and diagnostic services for all cancer screenings are covered at no expense to consumers.