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A popular home test for colon cancer has come with an unexpected bill for some people — leading to fears that they may postpone life-saving treatment. Americans may be used to watching commercials for Cologuard, a home test advertised as a way to screen for colon cancer at home rather than a more complicated colonoscopy. Experts say it’s a good checking tool, but some users said they’ve encountered a high bill.
Missouri native Leanne Bryant told CBS News investigative reporter Anna Werner that she was intrigued after watching Cologuard commercials on TV for a few years.
“I thought, ‘Hey, this at-home scan that I can do looks so easy compared to a full colonoscopy,'” Bryant, 55, told CBS News.
She called her insurance company in August to inquire about Cologuard.
“They said yes, it would be fully covered, because I didn’t want to be caught with an unexpected bill,” she said.
I sent in her sample and waited for an email with the results. To Bryant’s surprise, the test result came back positive.
Medical roulette price more more
She remembers thinking “I could have a polyp, I could have colon cancer.”
Bryant ended up needing a colonoscopy after all, but was relieved to have a negative result.
Then the bills started arriving.
“I started receiving data from my hospital that I had a balance of $1,900,” Bryant said. “I’m thinking, OK, I definitely don’t owe that much. I mean, it’s not possible.”
Colon cancer is highly treatable if caught early. Colonoscopy is done free of charge for most people over the age of 45.
Under the Affordable Care Act, only routine screening tests are covered, and because Bryant’s Cologuard result was positive, her colonoscopy was coded as a “diagnostic” test, which is not fully covered by her insurance.
It would have been completely covered if you hadn’t used Cologuard first.
“I am crazy because I pay so much every month for this insurance,” Bryant said. “I just feel like I’m really falling apart.”
CBS News polled 11 of the largest health insurance companies in the United States to find out what they would do in situations like Bryant’s. Seven did not respond. The four people who said coverage decisions differ, and how much a consumer will pay depends on how doctors code the colonoscopy procedure.
“Unfortunately, in some cases, people with a positive non-invasive test like Cologuard will have to pay out of their pockets for a colonoscopy,” said Dr. Mark Fendrick of the University of Michigan, who studies medical pricing.
Fendrick worries that when people find out that their colonoscopy may not be covered, they won’t get it, even if they have a high risk of colon cancer.
“The fact that people are considered to be at higher risk, and that it is not easy financially or otherwise to get a colonoscopy, makes absolutely no sense to me,” he said.
Cologuard is manufactured by Exact Sciences. Company Chairman and CEO Kevin Conroy agrees there is a problem.
“If someone gets a bill associated with the screening, that means one person is too much,” he said.
Conroy said his company decided it needed to add a new language to its website, saying that while “millions of patients can access this follow-up colonoscopy without out-of-pocket costs…not all of them do.”
“Raising this has helped us highlight what we can do best,” he told CBS News. “And so we’re always looking for ways to improve.”
However, while frequent television advertisements state that the cost of Cologuard itself is covered by most insurance policies, they do not mention that follow-up colonoscopy may not be covered.
Conroy defended the messages in the ads as “appropriate”.
“If what you’re doing is scaring people out of getting tested altogether, there’s a huge cost associated with that,” he said.
Leanne Bryant said she wished those ads had given her some warning.
“I don’t want to say it’s a hoax, but in a way, it’s just exploitation of people. If it happens to me, I know it will happen to a lot of people,” Bryant said.
The researcher believes Dr. Findrick that any issues with ads wouldn’t matter if entire colon cancer screening was required for insurance.
“I hope your story will not only raise awareness among your observers, but also among fee-payers, to see how unreasonable this policy is,” Fendrick said.
Cologuard has a program to help people file an appeal if they get an unexpected bill to pursue a colonoscopy. Bryant finally won her appeal to get her insurance company to pay her $1,900 bill, but it took five months to resolve it.
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