Top 5: Need to Know About Choosing Sedation for Your Colonoscopy

Our Conversations Webinar Series is an opportunity to link national experts in colorectal cancer and other related fields to you, right in the comfort of your own home. The programs are designed to empower you to play a leading role in you healthcare management.

You have a choice when it comes to colonoscopy sedation and we’re here to help make that decision easier. That’s why we hosted the webinar “Choosing the Right Sedation for Your Colonoscopy” last month where Anesthesiologist Mark Murphy, M.D., shared his experiences and expertise on sedation and anesthesia for colonoscopy procedures.

If you couldn’t make the webinar, take a look at the replay along with the top 5 takeaways!

1. Your colonoscopy bill may include many different components, such as bowel prep, colonoscopy procedure, sedation (type of sedation and whether an anesthesia professional is present or not), pathology (tissue examination by a pathologist) and type of facility (where procedure is done) such as Hospital [HOPD]; Ambulatory Surgery Center [ASC]; Physician’s Office [PO]

2. The costs may depend on the type of colonoscopy procedure which may be one of the following:

   • Screening Colonoscopy - an exam of your entire colon to look for signs of colon or rectal cancer. This should be covered by insurance under the Affordable Care Act Preventative Services.
   • Therapeutic Colonoscopy – if a polyp/lesion is found/removed during a screening colonoscopy, the procedure may change to a therapeutic colonoscopy (may be billed differently)
   • Diagnostic Colonoscopy - an exam of your colon for existing symptoms such as bleeding or pain

3. There are different types of fees and charges associated with your colonoscopy procedure, such as:

   • Technical Fee - the fee the facility charges (HOPD, ASC, PO)
   • Professional Fee - the fee paid to your doctor / the healthcare provider(s)
   • Billed Charge - the amount the provider charges the insurance company
   • Reimbursement / Allowed Amount - the amount actually paid by your insurance company
   • In-Network - means your insurance company has an agreement with your physician and/or facility to provide services. If the physician or facility is “out of network” your cost may be much higher.
   • Co-Pay - a fixed amount you pay for a health care service. With most plans, you should not be charged a copay or coinsurance for in-network preventive services like colonoscopies.
   • Deductible - the amount you pay for services before your health insurance begins to pay.
   • Coinsurance - your share (usually a percentage) of the costs of the health care services charged. You start paying coinsurance after you've paid your plan's deductible.

4.  There are different sedation options for your colonoscopy, including:

   • No Sedation
   • Minimal to Moderate or “Conscious” Sedation - usually involves intravenous (IV) doses of sedatives and pain medications. You should be comfortable, but not totally unconscious.
   • Deep Sedation and General Anesthesia – usually involves an anesthesia professional administering propofol with a pain medication. You should not feel or remember anything.
   • The SEDASYS^® System- FDA-approved Computer-Assisted Personalized Sedation (CAPS) System. Used by specially trained gastroenterologist and nurse teams to administer propofol for minimal-to-moderate sedation, without an anesthesia professional at the bedside

5. It’s important to ask your physician and insurance company sedation and financial questions, such as:

• • Are my gastroenterologist and facility “in-network” for my health insurance plan?
  • Is my colonoscopy procedure covered under my insurance plan?
  • If a polyp is found and removed, will this also be covered?
  • What sedation options do you offer at your facility and what if I want a different sedation option?
  • What sedation do you recommend for me and is there an additional charge for this sedation option?
  • Can you do my colonoscopy at another facility for less cost?
  • Considering all the fees and charges, what out of pocket expenses will I be responsible for?