Earlier this year the Obama administration cracked down on insurers trying to force patients to pay if a polyp is found and removed. However, some insurers are now requiring patients to pay for any follow-up colonoscopies by considering them diagnostic.
Requiring a cost share goes against the law’s intention, and Robert Smith, PhD, of the American Cancer Society, says the intent of the law has gotten lost in translation.
Practices can get caught in the gray area as to whom is responsible for the colonoscopy caught. Also, the CPT modifier 33, which indicates the cost share should be waived, cannot yet be processed by insurers despite being added at the beginning of 2012.
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