If you're over 50, you need a colonoscopy, so make sure your insurance covers it.
At a certain age, a colonoscopy is necessary. It is a relatively straightforward procedure that protects you from developing colon or bowel cancer and can stop it from progressing.
Since you're guaranteed to need one, it could be a good idea to see if health insurance covers colonoscopies. It's included in a basic policy so the procedure doesn't need to break the bank.
When might you have a colonoscopy?
A colonoscopy is a medical procedure that examines the large bowel. It's the most accurate test for cancer of the colon and rectum. Growths can develop on the lining of the colon and sometimes become cancerous.
Colon or bowel cancer screening usually begins at the age of 50 for most people. If a colonoscopy doesn't find anything abnormal, you shouldn't need a test for another ten years.
It is not just a requirement when you reach a certain age. You may also need a colonoscopy if you have any of the following symptoms:
- Bleeding from your rectum.
- Blood in your stool.
- Pus or mucus in your stool.
- Unexplained abdominal pain.
- Unusual changes in your bowel habits.
- Your family have a history of colon cancer.
- You have Crohn's disease.
Cost of a colonoscopy
If you are unregistered or uninsured, a colonoscopy could cost over $2,000. It's a procedure you will have at some point in your life, so it's worth considering whether you'd like to have it done privately or through the public system.
How does Medicare cover colonoscopies?
As a public patient in a public hospital or clinic, you'll generally have little to no out of pocket expenses for treatment, as the procedure is covered by Medicare. Unlike the private system, you will be assigned a specialist for the procedure; you won't be able to choose your own doctor.
You will also go on a waiting list for a colonoscopy. Demand for colonoscopies is very high. The average public waiting time is just under 7 months, far longer than the recommended 30 days for those who need it. Indeed, Bowel Cancer Australia says that less than 20% of us who require a colonoscopy aren't getting it within the recommended 30 days. If you need a colonoscopy urgently, or you want to receive treatment quicker, you could opt to go private for shorter waiting times.
Average public vs private wait times in Australia for colonoscopies
Source: Australian Institute of Health and Welfare (AIHW) Private health insurance use in Australian hospitals 2006–07 to 2016–17
How does private health insurance cover colonoscopies?
One of the perks of being a private patient is greater freedom of choice. You'll be able to select your own doctor, when you want the colonoscopy and book in for any prior consultations to discuss the procedure.
While this isn't necessary for everyone, if you have certain health issues like Crohn's disease or bowel cancer, it's likely to give you greater peace of mind knowing you can choose someone you trust.
Similarly, if you've been living with your condition for some time, or simply want a shorter waiting time, you can choose your own specialist.
With a colonoscopy, your private health insurance policy generally covers most of the cost of your procedure, though you are likely to face a small out of pocket expense, depending on your excess, overnight fee, doctor and hospital price. Most basic policies cover colonoscopies for around $70 a month.
Here are some of the ways you can work out a price estimate:
- Call your doctor or specialist to get a price.
- Ask if your doctor is in your private health insurance provider's preferred list.
- Ask for an extras cost.
- Make sure there are no hidden out of pocket expenses.
- Ask for a Medicare code.
- Call your private health insurance provider and give them your Medicare code.
- Find out your doctor's estimated rebate.
Health insurance with colonoscopy cover
Below are some examples from Finder that cover Colonoscopies. All quotes are based on a singles hospital policy in Sydney, NSW.
|Fund||Policy||Cost per month||Apply|
|Basic Hospital||$83.20||Go to Site|
|White Boost||$83.95||Go to Site|
Health Insurance Reforms coming April 2019As part of the reforms to the Australian health insurance system, we will see hospital policies placed in four categories: gold, silver, bronze and basic.
Each of these tiers includes cover for a minimum number of clinical categories. If you wish to continue to claim benefits for colonoscopies, you will need a policy of Bronze tier or higher.
Before the procedure, you'll need to discuss a range of issues with your doctor:
- It's not recommended to be on blood thinning tablets like aspirin when the procedure is performed so discuss this with your doctor beforehand.
- You need a clean bowel so that the doctor can see the colon lining. You may be told to adjust or change your diet and avoid specific foods before the procedure.
- Sometimes you will be given a "bowel preparation kit" and instructions on how to use it. The kit contains substances that help cleanse the bowel.
- You may be given laxative tablets to help cleanse your bowel.
- You'll be required not to consume food or drink prior to the procedure.
You will receive sedation intravenously prior to the procedure so that you don't feel anything during the colonoscopy.
The doctor will make sure you are lying on your left-hand side with your knees tucked up to your chest. The colonoscope – a long, thin, flexible instrument connected to a camera – is gently inserted through the anus and up into the colon.
Once the colonoscope has reached the point where the colon joins the small intestine, the doctor will slowly withdraw it while looking carefully at the colon lining. The optics of the colonoscope transmits a video image from inside the bowel to a screen and the design of the colonoscope allows for instruments to pass through the channel of the scope to remove any unwanted tissue.
If any abnormal tissue or lumps are found during the colonoscopy, it's removed and the tissue is sent for analysis to check for cancer.
How long does a colonoscopy take?
A colonoscopy doesn't usually require an overnight stay. You can usually return home the same day. The examination generally takes less than half an hour but the sedative can stay in your bloodstream for up to a day. Following the procedure, you'll stay in bed for around two hours until the sedation wears off.
If something abnormal is found, you'll receive a follow-up consultation and a plan will be put into place.
What are the side effects of a colonoscopy?
A colonoscopy can take a toll on your body, so you can expect to feel tired for a while following the procedure. It's also common that you'll experience some bloating and wind as air may still be trapped in the bowel, but this is normal. You may have a small amount of bleeding if you had any lumps removed.
While these side effects are common, you should contact your doctor if you have any of the following:
- Chills or fever
- Significant rectal bleeding
- Swelling or redness at your IV site
- Consistent nausea and vomiting
- Severe thirst
- Dizziness or headaches