Virginia law expands insurance coverage for cancer screening

Colorectal cancer screening saves lives. But too many Virginians get a surprise bill from their insurance or simply cannot afford to pay to complete the screening. The new law requires that insurance companies cover all colorectal cancer screening tests approved by the U.S. Preventive Services Task Force.

There are several options for colorectal cancer screening, and many Virginians are choosing at-home tests such as a fecal immunochemical test, or FIT, or Cologuard. These tests are effective, noninvasive and more convenient. But if the test is positive, screening is not complete until you get a colonoscopy. Here’s where the surprise bill comes in. Insurance companies would pay for the FIT or Cologuard test but would charge you for at least part of the colonoscopy. The new law goes into effect Jan. 1 and requires health insurers to cover the cost of a follow-up colonoscopy.

Why do I need a colonoscopy if my at-home, stool-based test is positive?

At-home colorectal cancer screening tests look for blood or DNA in the stool. If the test is positive, a colonoscopy should be performed soon — preferably within six months. The follow-up colonoscopy may find colorectal cancer, but more often it detects precancerous polyps, which can be removed to reduce your future risk for cancer.

Unfortunately, it won’t cover the cost of colonoscopy if you’ve had precancerous polyps in the past. Insurance companies consider these kinds of colonoscopies “diagnostic” and still require patients to pay for a portion of their colonoscopy in this case. Additional legislation would be needed to cover the full cost of screening for patients with a history of precancerous polyps.

Colon cancer is the No. 1 cancer killer in men younger than 50. Black Americans are more likely to get colorectal cancer and are more likely to die from the disease. Most people who get colon cancer do not have a family history of the disease.

Many Virginians don’t realize they are at risk for colorectal cancer or may not know that regular screenings can reduce the risk of getting colorectal cancer. On-time screening starts at age 45 and may start earlier if you have a family history of colon cancer. Talk to your doctor about which screening test is right for you, or visit UVa’s colorectal cancer screening webpage: uvahealth.com/services/colon-health/colon-cancer-screening.