Does my plan cover cologuard test instead of colonoscopy? What is my out of pocket for this screening? IS a colon screening considered a preventive procedure?
Good afternoon, and thank you for reaching out to us today! I would be happy to review your colonoscopy/cologuard coverage with you today.
Ultimately, your benefit coverage will depend on the reasoning for the colonoscopy service itself. According to your specific benefit plan, a preventive screening colonoscopy, performed in network, is payable 100% by Humana, under your preventive care benefits.
If for some reason there is a medical concern in nature leading up to the service being needed, then this is payable at a 50% coinsurance level, once your $6500 deductible is met. (also applies to services performed in network) There is a plan maximum out of pocket of $7150.
This applies to those services performed in network.
The cologuard screening itself does have to meet different requirements in order to be eligible for coverage. I have included our coverage document link here for your review:
Medical and Pharmacy Coverage Policies - Search Results
You can also view your benefit coverage, and locate an in network provider by following the instructions here:
How do I find out my benefit information?
What providers are in my network?
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