Monday, June 16, 2008

Medicare offers colonoscopy at any age re: colorectal cancer screening : HOW BCBSNC SKIRTS THE ISSUE OF PROVIDING FOR COLORECTAL CANCER SCREENING

The following information was gathered from: GAO-04-713 Colorectal Cancer Screening Test Coverage : : Government Accounting Office: GAO

What is the purpose of screening for colon cancer?:

"...Surviving colorectal cancer is greatly enhanced when the disease is detected and treated early; however, only 38 percent of colorectal cancer cases are diagnosed at an early stage, according to ACS...."

How preventable is colon cancer when utilizing screening?:

"Colorectal cancer is one of the most preventable cancers. Screening tests can help prevent colorectal cancer by finding pre-cancerous polyps so they can be removed before they turn into cancer. "

How do you screen for colon cancer?:

".....To facilitate early diagnosis, ACS recommends regular colorectal cancer screening for certain individuals using at least one of four key tests: FOBT, flexible sigmoidoscopy, DCBE, and colonoscopy. These tests are used to find potential signs of colorectal cancer, including polyps—abnormal growths in a person’s colon—or blood in a person’s stool. FOBT is a laboratory test used to detect blood (that is otherwise not visible) in stool samples that are collected by patients at home. Using a flexible sigmoidoscopy, a physician can find and take samples of polyps in a patient’s lower colon and rectum. DCBE detects polyps by providing x-ray images of a patient’s entire rectum and colon. Finally, a colonoscopy allows a physician to find and take samples of polyps in a patient’s rectum and entire colon as well as remove most polyps found during the test."

What is the recommended frequency of screening?:

"....ACS guidelines recommend that, beginning at age 50, all average-risk individuals be screened annually using an FOBT; every 5 years using a flexible sigmoidoscopy or DCBE; or every 10 years using a colonoscopy...."

Why does American Cancer Society (ACS) recommend that screening start at age 50?

"Risk increases as we age. The risk of developing colorectal cancer increases with age. In fact, most cases (92%) occur in people 50 and older.'

Does Medicare cover colorectal screening?: YES

"Medicare helps pay for colorectal cancer screening tests. People with Medicare Part B coverage who are age 50 or older are eligible for colorectal cancer screenings. However, in the case of colonoscopy, there is no age limit. Several different screening tests can be used to test for polyps or colorectal cancer. Each can be used alone. Sometimes they are used in combination with each other. The following screening tests are covered by Medicare."

Is there colorectal screening utilizing colonoscopies for those insured with BCBSNC PPO? Not as associated with clinic based screening.

How many states, by law, cover preventive care re: colon cancer? (as of 2004):

"Twenty states had laws requiring private health insurance plans to cover colorectal cancer screening tests as of May 2004. In 19 of these states, the laws generally applied to group or individual health plans, and required coverage of all four tests—FOBT, flexible sigmoidoscopy, DCBE, and colonoscopy—typically consistent with ACS guidelines.

Was NC one of the states stated by the GAO to 'require by law private insurance coverage of colorectal cancer?: YES

Table 1: State Laws Requiring Private Insurance Coverage of Colorectal Cancer Screening Tests : Scope of state laws States Number of states

Apply to fully insured group or California, Connecticut, Delaware,
individual plans and screening test coverage according to ACS guidelines District of Columbia, Georgia, Illinois, Indiana, Maryland, Minnesota, Missouri, New Jersey, Nevada, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Virginia, West Virginia

Table 5: State Colorectal Cancer Screening Laws for Private Health Insurance
p. 18:

State Law generally applies to group/individual Law generally requires coverage consistent
w/ ACS guidelines

North Carolina (2002) Yes Yes

So, how does BCBSNC get away with not providing colorectal cancer screening in NC?
ACS Comments : The GAO report states itself, as associated with criticisms of its report: "(we) did not independently verify the responses of the insurers and employers we contacted. "


BCBSNC offers no colorectal screening in western NC except in Boone, NC---ONE gastroenterology practice. And that is an office based procedure, not clinic based.

How big is western NC?

Western North Carolina generally consists of 23 counties. NC has 100 counties.

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