Some people who go in for a routine screening colonoscopy (fully covered by most insurance) can end up with a surprise bill of several hundred dollars, if the doctor detected and removed one or more polyps.

Under current law, Medicare beneficiaries must pay a coinsurance when their screening colonoscopy also involves the removal of polyps or other tissue—because it is reclassified as a “treatment” procedure. Additionally, while current law also requires most private payers to cover colorectal cancer screenings without cost-sharing (copays/ coinsurance/ deductible), private payers have interpreted the rules differently. Some private payers waive cost- sharing when a screening involves the removal of polyps or other tissue; others do not.

Two weeks ago, we scored a partial victory. The Department of Health and Human Services issued a regulation change stating that private insurance companies cannot charge patients for the removal of a polyp during a screening colonoscopy. The HHS ruling this week was a result of a very productive meeting that we had at HHS last summer with a cooperative group of patient advocacy organizations and professional doctors’ associations.

This is progress, but this ruling doesn’t fix the Medicare policy—yet.

This is what Fight Colorectal Cancer does: Fight for you

For those of you who are new to Fight Colorectal Cancer, you’ll quickly learn that one of our strengths is being a respected, well-known voice in Congress and key federal agencies (e.g., National Cancer Institute, the FDA, Centers for Medicare and Medicaid Services, Dept. of Defense). Our staff and advocates monitor events 24/7 and work behind the scenes—often for months or years–on tedious details and complex issues with the decision makers. We’ve been partnering with other organizations since 2012 on this particular, knotty problem.

In last year’s Congress, Fight Colorectal Cancer was instrumental in the introduction of legislation in the House (H.R. 4120) that would correct Medicare law, and has lobbied the Department of HHS for a change in regulation.

We are working with our congressional allies to see if this HHS ruling may somehow spur the Medicare fix, while also continuing to work toward the reintroduction of a House bill (and a Senate bill) to get the job done in the 113^th Congress.

As soon as we get new House and Senate bill numbers for this year, we’ll issue an  Action Alert here so you can begin lobbying your congressional representatives.

What this means for patients:

• If you have private insurance, have a routine screening colonoscopy (not ordered to check out symptoms, or as a result of a positive stool blood test); and have precancerous polyps removed, your insurer cannot charge a copayment. (The HHS has ruled that removing precancerous polyps is an “integral part of a colonoscopy.” Under the Affordable Care Act, no copays can be charged for approved screening tests.)
• If you have private insurance, and your doctor determines that you are in a high-risk category (e.g., you have a family history of colorectal cancer) that is covered by screening guidelines, the same rules apply: No copayment for a screening colonoscopy that includes removal of precancerous polyps.
• If you have Medicare coverage, you may still be charged a copayment if a screening colonoscopy includes removal of a polyp.
• If you have either private or Medicare coverage, it appears that a followup colonoscopy ordered because of a positive FOBT (stool test for blood) is not considered a screening procedure, and is not covered by this rule change.

 Yes, it’s complicated. If you have questions or concerns, please call our Answer Line at 1-877-427-2111.

For more information:

* Click here for clarifications of Affordable Care Act coverage of screening, including colonoscopy:

* Read here about Fight Colorectal Cancer’s 2013 Legislative goals.

* For tools on making your voice heard, our 2012 Advocacy Handbook  is a great start. A 2013 version for this year’s Congress is in final production. Stay tuned.

Provided by Kaiser Health News

Experts were surprised this week when the latest government survey showed that consumers actually paid a slightly smaller share of the nation’s total health bill in 2011, even though more people now pay higher deductibles.

Total U.S. spending on health care grew 3.9% in 2011 (including all medical goods and services, public health, cost of health insurance, investments, and government costs). That equals 17.9% of Gross Domestic Product (the same as 2009 and 2010) or about $8,680 per person in the nation.

Consumers paid just over one-quarter (28%) of total costs. Meanwhile, federal government health spending has risen more than three times as fast as consumer health spending since 2007, largely due to increased Medicare and Medicaid services for seniors and the disabled.

But many households hit hard by high deductibles

Even though the federal government is paying more of the nation’s total bill, individuals and families are paying a higher percentage of their personal income on health care. Household medical expenses are rising faster than the families’ income, according to government statistician Micah Hartman.

In 2012, one worker in three had medical insurance with a deductible of $1000 or more, meaning they must pay $1000 “out of pocket” before most expenses are covered. (In 2006, only one in 10 workers had a high-deductible plan.)

At the moment, the cost of higher deductibles is being partly offset by lower average prescription costs, as low-cost generics become more available for common medicines.

But more and more employers—as well as insurers under the new “health exchange” insurance marketplaces coordinated by the Affordable Care Act—will offer only high-deductible plans with pretax health savings accounts in the near future, according to employer and insurer surveys.

Fight Colorectal Cancer Answer Line and Upcoming Webinar Both Offer Advice

Public health officials worry that high deductibles may keep patients from getting needed screening or early treatment.

“One of the most common calls to our Answer Line right now is from people due for a colonoscopy, or unable to pay treatment copays, because they can’t afford their high deductible,” says Tavia Gilchrist, one of the friendly voices of Fight Colorectal Cancer’s Answer Line.

People may not have enough cash to pay a plan’s high deductible; or they’ve been laid off and lost all insurance; or they’re in a ‘grandfathered’ plan that isn’t yet required to offer free screenings. Gilchrist helps people define exactly what issue they’re facing, whether it’s insurance or Medicare rules, confusion about what a doctor is ordering, or a lack of local screening programs. “Every state – even areas within a state – is different,” she notes. Her job is to get callers started in the right direction to find answers to their specific question.

Webinar features expert on handling cancer finances

Speaking of questions, you can listen to plenty of answers in the live webinar “Addressing the Financial Burden of Cancer” on Wednesday, Jan. 16 from 8 to 9:30 pm EST. It features Elaine Martinez, a case manager with the Colorectal CareLine at the Patient Advocate Foundation.

Elaine serves as a liaison between colorectal cancer patients and their insurers, employers and/or creditors to resolve insurance, job, and/or debt problems. She helps investigate reimbursement levels for prescribed treatments, researches available clinical trials, and helps people enroll in resource programs for both uninsured and underinsured patients.

If you can’t listen in on Wednesday, the webinar will be archived for later listening, too.

Either way, you can’t afford to miss it.

Sources:

• “Who Knew? Patients’ Share of Health Spending Is Shrinking,” Jan. 14 Kaiser Health News;
• “Employer Health Benefits: 2012 Summary of Findings,” Kaiser Family Foundation and Health Research & Education Trust;
• 2011 National Health Expenditures report, Centers for Medicare & Medicaid Services;

• Fight Colorectal Answer Line: 1-877-427-2111

• Webinar: “Addressing the Financial Burden of Cancer”

Memorial Sloan-Kettering Cancer Center made a very public announcement—and explanation—today in a New York Times op-ed about why they will not offer the new drug Zaltrap® (ziv-aflibercept) to its metastatic colorectal cancer patients.

The authors, all world-renowned cancer specialists at the world’s oldest cancer center, in an op-ed headlined “In Cancer Care, Cost Matters,” essentially challenged other cancer centers to take action where politicians fear to tread.

“We recently made a decision that should have been a no-brainer,” wrote Drs. Peter B. Bach, Leonard B. Saltz and Robert E. Wittes. “The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price—at $11,063 on average for a month of treatment—is more than twice as high.” Read the rest of this entry »

The numbers are stark and will touch every single American.

A picture of cancer in the greying American population was drawn in a recent study in the Journal of Geriatric Oncology examining trends in the National Cancer Institute’s population-based SEER data:

The number of “oldest of the old” Americans (age 85 or older) will double between 2000 and 2030; and will have tripled by 2040 (from 4.3 million to 15.4 million).

• Cancer in the oldest old is the 2^nd leading cause of death: More than 1 in 5 over age 85 will develop cancer.
• The total cost of cancer care will rise 39% in just 10 years, between 2010 and 2020—much of that cost in care for elderly.
• Among those age 85 or above, colorectal cancer (CRC) is the most common cancer.

That’s some of the bad news. But the recent story of colorectal cancer, ironically, also brings a ray of hope. Read the rest of this entry »

Difficulty managing the cost of their cancer care stressed three out of four patients, according to a study recently completed by the Cancer Support Community.  In addition two out of three said their health care team didn’t discuss financial aspects of care with them.

In an effort to help patients struggling with cancer expense, the Cancer Support Community has just released Frankly Speaking about Cancer: Coping with the Cost of Care.

You can order a free print copy of the book, read sections online or download it. Read the rest of this entry »