How Much Does Insurance Pay For A Colonoscopy?

Your doctor will recommend a colonoscopy depending on the symptoms that you experience and when they think it is time to look at the inner lining of the large intestine. The colonoscopy test utilizes a flexible tube, which is half an inch in diameter with an onboard camera at one end. The doctor will pass colonoscope through the rectum to view the lining of the colon and find signs of polyps, ulcers, bleeding, and inflammation. The tube also helps the doctor to remove small tissues to perform a biopsy.

The Cost Factor

Before the doctor asks you to take a colonoscopy, he or she will provide the necessary information related to it and help you prepare for the same. It is natural for you to find out about the information related to the test and how it is helpful by having a conversation with the doctor. However, you will fail to hear the exact cost incurred for the entire procedure.

The cost of the entire procedure is dependent on a few factors, which are:

  • Geographical location
  • The overall health of the attendee
  • Where the doctor chooses to perform the test
  • Whether the doctor collects sample tissue.

How Much Does Insurance Pay For A Colonoscopy?

How Much Does Insurance Pay For A Colonoscopy?

How much does health insurance pay? If you have a health insurance policy, then it is possible that you will be paying very less towards the charges incurred for colonoscopy. It is difficult to tell about the final payout that the health insurance company will provide you, as it changes according to the insurance plan that you own and the coverage it gives. The deductibles aggregate between zero and above thousand dollars. If you do not have health insurance, you will be shelling between $2,000 and $4,000. On the contrary, if you have a Medicare, you will be paying 20% of the approved amount from the Medicare towards the doctor’s services apart from the copayment incurred on the outpatient charges.

The Breakup Of The Charges

The total amount of the colonoscopy includes not only the physician charge but also the following:

  • Colon preparation kits
  • Differentiation in the fee due to the diagnosis that the doctor performs
  • The use of the sedation and whether a licensed anesthesiologist administers the same
  • The cost incurred in examining the tissue extracted

Health Insurance Advantage

If you own a health insurance policy, then you are entitled to 100% of the charges incurred for colonoscopy. The amount that insurance company releases is dependent on the contract it has with the medical provider. Although you can opt for an out-of-network hospital, you may need to shell out in addition to the amount released by the insurance company. However, if you conduct the test within the in-network providers listed by the insurance company, you will be paying less, and in some cases nothing.

Additional Cost Considerations

A few organizations, hospitals, and government programs offer free colonoscopy or low-cost screenings for underinsured or uninsured individuals. Depending on the status of the patient, it is feasible for a doctor to conduct a flexible sigmoidoscopy than colonoscopy. The doctor can perform the test in his or her clinic and will last between 20 or 30 minutes. The test does not require the use of sedation and will cost around $200. On the contrary, this flexible test may not suit everyone, as it helps the doctor to view only half of the intestine.


If you are conducting the examination outside the network coverage provided by the hospital, you may be shelling additional amount towards the expenses. You can minimize the cost by choosing in-network hospitals. Working closely with your doctor is advisable to determine the frequency of the test, which helps in predicting the expenses.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 7, 2018

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