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A colonoscopy isn’t always a one-and-done expense. While the procedure itself is the main event, there can be additional costs afterward that catch people off guard.
Things like pathology fees, anesthesia, and follow-up tests can add up quickly. If you’re not prepared, you might end up with an unexpected bill that no one wants to deal with.
Let’s go over what you can expect when it comes to post-colonoscopy costs and how you can keep them as low as possible.
What You Might Pay After a Colonoscopy
A colonoscopy itself has a price tag, but there are a few other expenses that might come into play depending on your situation. Here’s a breakdown of some common follow-up costs:
Biopsy Costs
If your doctor finds any polyps (small growths in your colon), they’ll likely remove them and send them for testing. The more polyps they remove, the higher the cost of the biopsy.
As Jeanne Pinder noted in her blog post How much does a colonoscopy cost? $600 or $16,000?, the lab tests can vary significantly:
“What happened to me: I had $250 in lab charges, all covered except for a $30 co-pay (before the Affordable Care Act); my girlfriend’s lab charges were $950, about the highest I’ve heard. For her, it was completely covered, but of course that’s not always true.”
Pathology Fees
Once the polyps are removed, a pathologist examines them to check for cancer. Each biopsy gets analyzed separately, which means the cost goes up if multiple samples are tested.
Anesthesia
Most colonoscopies require sedation, and in some cases, an anesthesiologist is involved. If they are, their fees might be billed separately from the procedure itself.
According to UCLA Health, patients may face unexpected costs related to anesthesia during a colonoscopy. If insurance does not cover monitored anesthesia care, individuals may be responsible for a flat fee of $200.
Even when insurance does cover it, co-insurance and deductibles could exceed $200, depending on the policy.
Facility Fees
Where you have your colonoscopy matters. Hospital-based procedures tend to be more expensive than those performed at independent outpatient centers.
- Colonoscopy without biopsy: Facility fees average around $125.91
- Colonoscopy with one or more biopsies: Facility fees average around $160.81
Follow-Up Procedures or Medication
If your results indicate something that needs further testing, you might have additional imaging or even a repeat colonoscopy. Depending on what’s found, your doctor may also prescribe medication, adding to the overall cost.
- Colonoscopy with additional procedure: according to a study by the University of Michigan’s Center for Value-Based Insurance Design and affiliated departments, follow-up procedures for colonoscopies can range anywhere from $220 to $1,499.
Potential Complications
Complications aren’t common, but if they do happen, they can lead to extra medical bills. Issues like bleeding or perforation of the colon could require hospitalization or further treatment.
According to Verywell Health, “Studies estimate the overall risk of complications for a routine colonoscopy to be low, around 1.6%.”
How Insurance Plays a Role
If you have insurance, your out-of-pocket costs will depend on what’s covered and what’s not.
Sometimes, different parts of the procedure are billed separately, which can be frustrating when you think you’re covered but end up with an unexpected charge.
For example, your gastroenterologist may be in-network, but the anesthesiologist might not be. That could mean a surprise bill even though you thought everything was covered.
Here are a few key insurance terms to keep in mind:
- Screening vs. Diagnostic Colonoscopy: A screening colonoscopy is preventive and often fully covered. But if it’s considered diagnostic (done because of symptoms or a previous issue), coverage may be different.
- Deductible: The amount you have to pay before your insurance starts covering costs.
- Co-pay: A set fee you pay at the time of service.
- Coinsurance: The percentage of costs you share with your insurance after your deductible is met (e.g., 80/20 means your insurance covers 80%, and you pay 20%).
- Out-of-Pocket Maximum: The most you’ll have to pay in a given year before insurance covers everything at 100%.
How to Keep Follow-Up Costs Low
No one wants to spend more than necessary on medical bills. Here are a few ways to manage costs:
| Ways to Keep Follow-Up Costs Low | Details |
|---|---|
| Ask for a Good Faith Estimate | Request a detailed estimate from your provider before the procedure. This helps you understand expected charges, including anesthesia and pathology. |
| Compare Prices | If paying out of pocket, research different providers for lab testing and pathology services to find lower-cost options. |
| Check for Financial Assistance Programs | Many hospitals offer financial aid or charity care programs that can reduce or eliminate costs for qualifying patients. |
| Consider Affordable Healthcare Providers | Programs like ColonoscopyAssist provide flat-rate pricing, eliminating surprise fees, an affordable choice if you’re looking for a colonoscopy without insurance |
| Review Your Bill for Errors | Request an itemized bill and compare it with your Explanation of Benefits (EOB). Look for: incorrect codes, upcoding, unbundling, and duplicate charges. |
Final Thoughts
No one likes dealing with unexpected medical bills, but a little planning can go a long way in keeping costs under control.
Getting a good faith estimate, checking your insurance coverage, and reviewing your bill for errors can help you avoid paying more than necessary.
Your health is important, and so is keeping your finances in check. With the right information, you can do both.
Disclaimer
Before making any decisions regarding anesthesia, sedation options, colonoscopies, or any medical procedure, always consult with your physician, anesthesiologist, or qualified healthcare provider. This article should not be used as a substitute for professional medical advice, diagnosis, or treatment.
