Anthemmy

Healthcarereformat-a-glancePreventivecarecoverage:ColonoscopyprocedureTheAffordableCareAct(ACAorhealthcarereformlaw)requiresnongrandfatheredhealthplanstocoverevidence-informedpreventivecareandscreeningsprovidedforincomprehensiveguidelinessupportedbytheHealthResourcesandServicesAdministration(HRSA)departmentofHealthandHumanServices(HHS),whentheservicesarerenderedbyanin-networkproviderand/orfacility.
Colorectalcancerscreeningreceivedan"A"ratingfromtheUnitedStatesPreventiveServicesTaskForce(USPSTF),meaningthatthereisahighcertaintythatthenetbenefitismoderatetosubstantialandthattheUSPSTFrecommendstheservice.
However,noteverycolonoscopyisdoneforscreeningpurposes.
Manyaredonefordiagnosticpurposesafterthepatientpresentswithsignsorsymptoms.
Therearetwotypesofcolonoscopyprocedures:1.
Screeningcolonoscopyprocedures,and2.
DiagnosticcolonoscopyproceduresBecausethesameproceduremaybedoneforeitherapreventivescreening,orasadiagnosticprocedure,Anthemmustrelyonproviderbillingtoaccuratelyidentifytheserviceaspreventiveordiagnostic.
ListedbelowisAnthem'scoverage,basedonthecurrentproceduralterminology(CPT)code(s)billedbytheprovider.
Colonoscopiesthataredoneforscreeningpurposesanduseanappropriatepreventivescreeningdiagnosiscode(evenifpolypsareremoved)arecoveredasapreventivescreeningwithnomembercostshare(suchascopayment,coinsuranceand/ordeductible).
oAnesthesiachargesandotherassociatedfacilitychargesarealsocoveredaspreventivewhenthecolonoscopyisbilledwithanappropriatepreventivescreeningdiagnosiscode.
Colonoscopiesthataredonefordiagnosticpurposeswhenthememberpresentswithsymptomsshouldbecoveredasaregularmedical/surgicalservice,andtheprocedurewillbesubjecttomemberbenefitsandcouldhavecostshare(suchascopayment,coinsuranceand/ordeductible).
Itisrecommendedthatmembersundergoingacolonoscopyasapreventivescreeningconfirmthattheproviderandfacilityarein-network.
In-networkprovidershavebeeneducatedonpreventivebenefitsunderthehealthcarereformlaw.
Thiscontentisprovidedsolelyforinformationalpurposes.
Itisnotintendedasanddoesnotconstitutelegaladvice.
Theinformationcontainedhereinshouldnotberelieduponorusedasasubstituteforconsultationwithlegal,accounting,taxand/orotherprofessionaladvisers.
TheAnthemNationalAccountsbusinessunitservesmembersof:AnthemBlueCrossLifeandHealthInsuranceCompanyandBlueCrossofCaliforniausingthetradenameAnthemBlueCrossinCalifornia;usingthetradenameofAnthemBlueCrossandBlueShieldforthefollowingcompaniesin:ColoradoRockyMountainHospitalandMedicalService,Inc.
HMOproductsunderwrittenbyHMOColorado,Inc.
Connecticut:AnthemHealthPlans,Inc.
;Georgia:BlueCrossandBlueShieldofGeorgia,Inc.
andBlueCrossBlueShieldHealthcarePlanofGeorgia,Inc.
;Indiana:AnthemInsuranceCompanies,Inc.
;Kentucky:AnthemHealthPlansofKentucky,Inc.
;Maine:AnthemHealthPlansofMaine,Inc.
;Missouri(excluding30countiesintheKansasCityarea):RightCHOICEManagedCare,Inc.
(RIT),HealthyAllianceLifeInsuranceCompany(HALIC),andHMOMissouri,Inc.
RITandcertainaffiliatesadministernon-HMObenefitsunderwrittenbyHALICandHMObenefitsunderwrittenbyHMOMissouri,Inc.
RITandcertainaffiliatesonlyprovideadministrativeservicesforself-fundedplansanddonotunderwritebenefits;Nevada:RockyMountainHospitalandMedicalService,Inc.
HMOproductsunderwrittenbyHMOColorado,Inc.
,dbaHMONevada.
;NewHampshire:AnthemHealthPlansofNewHampshire,Inc.
;Ohio:CommunityInsuranceCompany;Virginia:AnthemHealthPlansofVirginia,Inc.
tradesasAnthemBlueCrossandBlueShieldinVirginia,anditsserviceareaisallofVirginiaexceptfortheCityofFairfax,theTownofVienna,andtheareaeastofStateRoute123.
;Wisconsin:BlueCrossBlueShieldofWisconsin(BCBSWi),whichunderwritesoradministersthePPOandindemnitypolicies;CompcareHealthServicesInsuranceCorporation(Compcare),whichunderwritesoradministerstheHMOpolicies;andCompcareandBCBSWicollectively,whichunderwriteoradministerthePOSpolicies.
In28easternandsoutheasterncountiesinNewYork,EmpireBlueCrossBlueShield,thetradenameofEmpireHealthChoiceAssurance,Inc.
,underwritesand/oradministersthePPO,EPO,POSandindemnitypolicies.
IndependentlicenseesoftheBlueCrossandBlueShieldAssociation.
ANTHEMisaregisteredtrademarkofAnthemInsuranceCompaniesInc.
TheBlueCrossandBlueShieldnamesandsymbolsareregisteredmarksoftheBlueCrossandBlueShieldAssociation.