NJ Law Requires Health Insurance Companies to Cover Colonoscopies Starting June 1
In 2023, an estimated 4,220 New Jerseyans will be diagnosed with colorectal cancer, and by year’s end, an expected 1,360 residents will lose their lives to this preventable disease, according to statistics from The American Cancer Society.
Why is it important to get a colon cancer screening?
Very simply, colonoscopies save lives, said Dr. Howard S. Hochster, assistant cancer director for clinical research at Rutgers Cancer Institute of New Jersey.
He said during a colonoscopy, a gastroenterologist will remove any polyps (premalignant growths) that are found.
“We know that from the time a colon cancer cell starts to go bad, it goes through a series of gene mutations that first make it into a polyp-like growth, so an adenoma, and then it takes a few more years to become cancer. In that time period, the polyps can be removed and people won’t get colon cancer,” Hochster said.
Unfortunately, one of the biggest deterrents for people getting screened is the high out-of-pocket costs associated with screenings, especially colonoscopies.
Not all insurance companies cover colonoscopies for asymptomatic patients who don’t have a reason to get the test.
That’s the importance of legislation signed into law on Feb. 2 by Gov. Phil Murphy, Hochster said.
What is the NJ law regarding colon cancer screenings?
The new law, aimed at expanding access to preventive colorectal cancer screenings, will eliminate financial barriers to lifesaving screenings requiring health insurers to cover colorectal cancer screenings starting at age 45, recommended by the United States Preventive Services Task Force.
It also eliminates cost-sharing for colonoscopies performed following a positive result on a non-colonoscopy, colorectal cancer screening test.
Since colonoscopies can be very expensive if it’s not 100% covered by insurance, the new law also eliminates all out-of-pocket copays, Hochster said.
Right now, health plans don’t have to pay for a colonoscopy until age 50, but all of that will change, starting June 1.
“The law is attempting to lower the barrier for people by saying, you know what, get over it, decide to get the colonoscopy and you won’t have to worry about the financial implications,” he said.
When should people first start getting screened for colon cancer?
The age for asymptomatic people who are at average risk to get screened is now 45 years old, Hochster said.
But he says doctors have been seeing more colon cancer in younger patients which is baffling to them. So, if you’re in your 30s and you have ongoing problems including bowel issues, abdominal pain, and black or tarry stools, talk to your doctor about getting a colonoscopy or a CAT scan.
Oftentimes, he said physicians may think it’s just inflammation or colitis mainly because they don’t think people in their 30s could have colon cancer.
But Hochster said don’t let it go. If symptoms continue, you need to be screened.
If you have a first-degree relative, like a parent or sibling who had colon cancer, then you are at a somewhat higher risk than average, he said. So, you should get a colonoscopy about 10 years earlier than your first-degree relative.
Who is at risk for colon cancer?
Everyone is at risk, Hochster said. Colon cancer is the third most common cancer and the third most common cause of cancer death in the U.S.
But, the incidences are a little bit higher in African-Americans.
“That’s also a group that tends to be underinsured and have less access to health care. So, the current law may help these people get the colonoscopies more easily,” Hochster said.
How often should someone go for a colonoscopy?
Since everyone’s medical and family history is different, it’s important to speak to your gastroenterologist about how much time should pass in between colonoscopies, he said.
But, typically if no polyps are found, it’s usually between three and five years between colon cancer screenings.
What are the treatment options for colon cancer?
If someone is diagnosed with colon cancer, he said surgery is typically the plan of attack. Following the surgery could be preventive chemotherapy depending on the stage and the level of risk.
How does the future of colon cancer screenings look?
“We’re also, I think, going to change the way we look at risk in the next few years through the use of tumor DNA in the blood,” he said.
When any cell dies, it gives off some DNA, meaning there’s a lot of cell-free DNA floating around in the bloodstream. But, today with better DNA sequencing techniques, doctors will be able to detect small numbers of molecules of DNA that’s coming from cancer, he said.
“So it seems like people who have had surgery and continue to show traces of tumor-DNA in the blood are at a higher risk than people whose tests are negative,” Hochster said.
March is Colon Cancer Awareness Month and Hochster is encouraging everyone who has not done so and who is due, to get over the “ick” factor and schedule a colonoscopy to help save your life.