GAO: Most Private Health Plans Cover Colorectal Screening

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Even in states without colorectal cancer screening coverage requirements, most private health plans provide coverage for colorectal screening tests.

The U.S. General Accountability Office has published figures supporting that conclusion in a report on an informal study of colorectal screening coverage practices.

Cancer of the colon and rectum will kill almost 57,000 U.S. residents this year, Kathryn Allen, a GAO health care director, writes in the report, which was prepared at the request of Sen. Edward Kennedy, D-Mass.

Doctors say most people over age 50 should receive regular colorectal screening procedures, but fewer than half of U.S. residents in that age group who were surveyed in 2002 said they had ever received any colorectal cancer screening services, Allen writes.

Doctors depend on 4 screening tests to detect colorectal cancer. They are fecal occult blood tests, double-contrast barium enemas, flexible sigmoidoscopies and colonoscopies.

Allen cites statistics from the U.S. Centers for Disease Control and Prevention that show that the typical cost of a screening procedure is about $10 to $25 for a fecal occult blood test, $150 to $300 for a flexible sigmoidoscopy, $250 to $500 for a double-contrast barium enema, and $800 to $1,600 for a colonoscopy.

GAO researchers found that 20 states require private health insurers to cover colorectal screening procedures.

The researchers also looked at screening benefits in 10 states without screening benefits mandates. The study included 5 states with large populationsFlorida, Massachusetts, Michigan, New York and Wisconsin. The study also included 5 states that were chosen at random. The randomly chosen states were Arizona, Arkansas, Colorado, Louisiana and Maine.

In states without official screening requirements, all of the 19 small group plans reviewed covered some colorectal cancer screening procedures, and 17 were willing to pay for more than a basic fecal blood test.

The researchers also found that 4 of the 14 individual plans reviewed refuse to pay for any colorectal screening procedures but that the other 10 plans pay for all 4 of the popular cancer screening procedures.


Reproduced from National Underwriter Edition, August 5, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.