2015-01-13 17:08:22 UTC

AGA Seeks Examples of Problems with Cost Sharing for CRC Screenings

Jan. 15, 2015

Medicare patient cost sharing for screening colonoscopies is waived under the Affordable Care Act. However, if the colonoscopy becomes therapeutic, patients are responsible for the co-insurance for the procedure. AGA has been working on this issue for several years. Now, HHS would like to hear from GIs who have stories and evidence of how this issue affects their patients.

AGA has been working diligently with ACG, ASGE, patient advocacy organizations and the National Colorectal Cancer Roundtable on fixing the Medicare patient cost sharing issue faced by beneficiaries when their screening colonoscopy becomes therapeutic. Under Medicare law, the cost sharing for a patient’s colorectal cancer screening is waived. However, if the colonoscopy becomes therapeutic due to a finding of a precancerous polyp or lesion, the patient is responsible for the co-insurance since the procedure is no longer deemed a “screening.” Read AGA's issue brief on this topic. 

Our organizations have met with the administration several times on this issue and believe they would like to fix this problem, but need to hear from gastroenterologists about how the policy is affecting their patients.     

Dr. Anand Parekh, deputy assistant secretary for health at HHS, has requested our help in providing evidence and/or data — empirical or anecdotal — of the impact that the Medicare colorectal cancer screening waiver problem is having on Medicare beneficiaries. Any information, patient scenarios or examples could help with our efforts to persuade the administration to use their regulatory authority to fix this problem once and for all. 

Please email any data or examples to Kathleen Teixeira, AGA senior director of government affairs. We thank you in advance for your help in trying to eliminate the barrier that beneficiaries face to lifesaving colorectal cancer screenings. 

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