Know Your Colorectal Cancer Screening Options

Know Your Colorectal Cancer Screening Options

Getting screened for colon cancer is an important way to protect your health.

Colon cancer is the third leading cause of cancer death in the U.S. But colon cancer can be successfully treated when it is found and treated early. Until it grows or spreads, colon cancer usually has no symptoms. So screening is vital for early detection.

Talk to your doctor about which type of screening test is best for you. There are several options. Some are simple in-home tests. Others, like a colonoscopy, are done by a doctor.

Colon cancer used to be a disease that mainly affected people over 45, but studies show it’s becoming more common in younger people. Catching it early gives people of all ages a better chance at successful treatment.

If you’re between the ages of 45 and 75, talk to your doctor about routine colorectal cancer screening. If a history of colon cancer runs in your family, speak up. You may need earlier testing.

Learn more about screening tests from the Centers for Disease Control and Preventionleaving site icon

Getting the care you need to protect your health is important. It’s also important to ask questions before your test so you understand exactly what you’re getting and what it costs.

Preventive and Diagnostic Tests

Asking questions up front can help you understand the type of test your doctor orders and how your health plan will pay for it. And as with other health visits, going to an in-network provider can save you money.

It’s important to know that there are both screening and diagnostic versions of many tests. For example, colonoscopies and mammograms have both types of tests.

A screening version is considered preventive care. Preventive screenings are routine tests ordered when there is no reason to suspect a problem. They are generally done at certain ages and intervals, like every two years.

Many health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for HMOs) or a doctor or medical center in your plan’s network (non-HMO plans).* That means you pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers in your benefit book.

If a person has symptoms or signs of a problem, a diagnostic test will be ordered. Diagnostic tests take a closer look to see if disease is present. A diagnostic test may be ordered if anything unusual shows up on a preventive screening test.

A diagnostic test is considered medical care, not preventive care. You will have out-of-pocket costs for diagnostic tests.

For a colonoscopy, how much you may have to pay is based on what is ordered by your doctor.

  • Preventive screening test: This is a routine colonoscopy for people who have no symptoms to suggest a problem. They have not had gastrointestinal problems in the past. 
  • Diagnostic test: This testing is for people who have certain known health problems. These may include anemia, gastrointestinal bleeding or blood detected by a stool test, or a prior colonoscopy where polyps were found and removed. You may have out-of-pocket costs for a diagnostic colonoscopy.
Get the Details on Your Costs

To avoid unnecessary or unplanned out-of-pocket costs, ask your doctor if the test being ordered is a preventive screening test or a diagnostic test. Ask again what test has been ordered when you make your appointment.

Give the person who books your appointment the specific information from your health plan ID card. Make sure that the provider who will do the procedure is in-network. And ask if there are other providers who will be involved. Additional providers may perform related services like anesthesia and blood tests. Make sure all of the providers involved are in your plan’s network.

Ask what facility you’ll be using and if it is in your plan’s network. And there may be additional costs for related services, such as bowel prep medicines, pathology tests and facility fees. Ask if you will have any related services that will affect your cost.

To make sure a provider or facility is in your plan’s network, use our Provider Finder® tool. Log in to Blue Access for MembersSM (BAMSM) and click on Find Care.

*If you have a grandfathered plan (a plan that was in existence on or before March 23, 2010), preventive care without out-of-pocket costs may not apply to you.
Sources: What is Colorectal Cancer Screeningleaving site icon Centers for Disease Control and Prevention (CDC), 2023; Colorectal Cancer Statistics, leaving site icon CDC, 2023; Colorectal Cancer, leaving site icon American Cancer Society

Originally published 9/29/2021; Revised 2022, 2023