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When A Screening Test For Colon Cancer Leads To A Pricey Follow-Up

After a Cologuard screening test for colon cancer comes back positive, patients may have to pay for additional diagnostic tests.
Exact Sciences
After a Cologuard screening test for colon cancer comes back positive, patients may have to pay for additional diagnostic tests.

When DNA colon cancer screening tests find abnormalities, are patients discouraged about getting more diagnostic testing because of costs they will incur? And why do hospitals sometimes send a second bill for treatments given in a doctor's office? Here are the answers.

A stool-based DNA test to screen for colon cancer is available that is readily paid for by health plans, including Medicare. But if I have a positive Cologuard test result, I'd have to pay several hundred dollars for a regular diagnostic colonoscopy. Doesn't this discourage people from getting screened for colon cancer, which is the goal, after all?

Patient advocates point to several reasons people may be discouraged from getting tested for colorectal cancer, including the "ick" factor and the time it takes to prepare for and get a colonoscopy, the most common screening test. "But the No. 1 factor is always cost," said Caroline Powers, director of federal relations at the American Cancer Society Cancer Action Network.

Commercial insurers and the Medicare program cover cancer screenings that are recommended by the U.S. Preventive Services Task Force without requiring any payment by patients. The task force, an independent panel of medical experts, recommends colorectal cancer screening for people from age 50 to 75.

Several different types of tests get the thumbs up from the task force, including colonoscopy, in which a flexible tube with a camera is snaked through the colon from the rectum to look for polyps and other abnormalities, and stool-based tests, including the DNA test you mention, which looks for genetic mutations associated with cancer or polyps.

But, as you point out, there's a potential hitch. If you get a positive test result from a DNA test or other screening method, you'll need to get a follow-up colonoscopy to check whether the test result was correct.

Patient advocates have argued that the follow-up colonoscopy should be provided without cost-sharing by patients, and doctors tell them that some private insurers are beginning to handle the process that way, Powers said. But in Medicare that follow-up test is still considered diagnostic, and seniors are responsible for any deductible and coinsurance charges. Patient advocates continue to lobby for a change to that policy.

"From a public health perspective, it goes against everything we're trying to do," Powers said.

I have carpal tunnel syndrome in both wrists. I visited a hand surgeon at his office who gave me a cortisone shot in my right wrist. His bill was $450, of which my insurance covered $420. But I also received another bill from the hospital with which his practice is affiliated that included a $1,702 facility fee for which I have a $400 co-payment. This seems so unfair. What can I do to avoid owing that charge?

There may not be much you can do after the fact. As hospitals continue recent efforts to purchase physician practices, hospital facility fees are increasingly common. In 2014, a third of doctors were either employed by a hospital or worked in practices that were at least partly owned by a hospital, an increase from 29 percent in 2012, according to a study by the American Medical Association. Even if the doctor's office is located across town, the physician practice essentially becomes part of the hospital, and patients are typically billed for both physician services and hospital facility charges.

Starting next year, some hospital facility charges will no longer be allowed. Under the Bipartisan Budget Act of 2015, Medicare will no longer pay hospital facility fees for outpatient services at physician offices that aren't located on the hospital campus. However, the change will apply only to practices that hospitals acquire after Nov. 15, 2015, and doesn't affect commercial insurers at all.

The best way to protect yourself from unexpected facility fees is to get details from the physician's office before you visit, said Richard Gundling, senior vice president at the Healthcare Financial Management Association, a group for professionals in health care finance. That way, you can make an educated decision about whether to proceed before you get a surprise bill. "The patient should always ask, 'What is my out-of-pocket cost for this visit?'"

My husband's family physician is a member of MDVIP, one of many "concierge" practices in which a doctor or group of doctors generally charge an annual fee for faster appointments, more access to the doctor, more time with him during appointments, and preventive services during the annual wellness visit that aren't included in a regular Medicare annual wellness visit. Is the annual fee of $1,650 tax deductible?

The annual fee is generally tax deductible, said Roy Harris, general counsel at MDVIP. That annual fee covers the cost of an executive physical every year for members, often a checkup with extra bells and whistles such as additional tests or screenings. If people itemize their medical expenses on their income taxes, they can generally deduct the expense as a physical exam.

Even if they don't itemize, many people get reimbursed from their flexible spending accounts or health savings accounts for the annual fee after getting their physical, Harris said.

Mark Luscombe, principal federal tax analyst at Wolters Kluwer Tax and Accounting, a software and information services company, agreed, although he noted that the Internal Revenue Service hasn't weighed in specifically on this issue.

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. You can follow Michelle Andrews on Twitter: @mandrews110.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Michelle Andrews