Is cologuard covered by cigna insurance?

Are you experiencing gut trouble or dealing with bowel issues that make you wonder if cancer could be the cause? There are plenty of options to help screen for colorectal cancer, but not all insurance companies cover them. One particular option is Cologuard – a non-invasive screening test actively used in detecting early signs of colon cancer. If your insurer is Cigna, you might be concerned about whether they’ll cover it or not.

What’s Cologuard?

Isn’t it funny how we always jump on decoding acronyms before understanding what products really do? In case one doesn’t know, Cologuard stands for colon and (the) guard(ian) a state-of-the-art multi-targeted DNA based stool analysis technology specially designed to detect any abnormal growth known as pre-cancerous polyps as well as unique biomarkers associated with colorectal tumors^1.

It’s often recommended when someone has reached an age where colorectal tumor screening must commence (50 years old) but can also apply if there are certain risk factors present such as family history, genetic susceptibility or predisposition ^2.

The big question remains though: will my insurance plan provide coverage?

Does Cigna Benefit Cover the Cost of Cologuards

A general response would be… maybe! A perfect answer might be hard to give since all medical covers run differently per individual depending on premium plans choosen by subscribers’ employers or individuals themselves alongside varying state regulations affecting each policy differently beyond federal protection laws embodied in Affordable Care Act popularly regarded as ‘Obamacare.”^3 That being said, it still begs the question: will your specific health care plan under Cigna offer the necessary provisions required for rolling out Cologuards text service at no extra cost?

Determining Cologuard Coverage

The first item on the menu would be to review your insurance organization’s policy on cancer screening coverage. In particular, it is crucial to see if comprehensive cancer prevention involving colon tests and treatment accords reimbursement provisions in relation to preventive services of USPSTF given that many insurers fall under those who respond within their purview^4.

On its part, Cigna health plan covers a broad range of colorectal screening procedures with approved recommendations by independent agencies such as the U.S. Preventive Services Taskforce (USPSTF), American Cancer Society (ACS), and National Comprehensive Cancer Network (NCCN) since these recommendations are considered evidence-based guidelines for identifying primary care preventative services^5.

In essence, individual policies shift what diagnostic benefits each subscriber has towards executing different available testing options inclusive within a routine check-up outpatient schedule or stipulate out-of-pocket affordability limits for non-invasive techniques like Cologuard designed with maximum benefit optimization in view.

Reducing Out-Of-Pocket Expenses

So far so good! You’ve done your research; discovered you have an eligible policy from your healthcare provider which expressly includes cologuard screenings procedure. However, there still remains concerns and uncertainties about finances relating to copayments/deductibles if any after provision of compliant documentation about suitability received before taking the test.
Fortunately from January 1st through March this year (Q12021), Exact Sciences Corporation entered into an agreement intending to reduce payment variability when employing Guardant Health’s liquid biopsy technology known as “Guardant360” alongside pre-existing collaborations with other laboratories across America showcasing wide adoption underscores commitment expressed toward making early detection affordable while extending optimized quality diagnostic options to at-risk populations especially in remote regions^6.

Getting Coverage Confirmation

Think you’ve done all that is required? Think twice, my friend!

Another consideration involves reaching out to the laboratory performing Cologuard screenings since Exact Sciences Corporation’sCancerguards works with ‘in-network’ labs and physicians right after test confirmation for reducing unnecessary expenses incurred. Therefore always ensure confirming ahead of time affiliations regarding availability pending coverage or then search for network providers whose fees incurred could hash down costs through contracted agreements between Cigna and such independent third-party testing facilities before applying directly ^7.

Final Thoughts

Phew! With everything said and concluded, it would be wise never skimping about delving deeper into available options taking note of premium amounts paid beside care plans chosen as well as seeking clarifications on coverage inclusions from your specific health-care provider should confusion come calling during billing routines.
Just don’t forget –

Carry-out routine screening per recommended guidelines
Claim tests earning full entitlements under insurance policy
and Stay healthy!

References:

1. https://www.fda.gov/news-events/press-announcements/fda-approves-first-non-invasive-dna-screening-test-colorectal-cancer
2. https://www.cologuardtest.com/
   3.https://benefitplace.blogspot.com/2019/01/do-insurance-plans-cover-cologuard-for.html#:~:text=According%20to%20the%20Healthcare%20Bluebook,and%20your%20employer’scoverage).
   4 .https://healthpolicy.duke.edu/sites/default/files/atoms/files/schwartz_olson_final.pdf
   5 .https://www.cigna.com/hcpbsm-idp/cms-content-viewer-static/docs/customer/cignacoveragepositions/CPP_0118_CDC_CC_GeneticScreeningforHereditaryColorectalCancerSyndromes.pdf
   6 .https://www.businesswire.com/news/home/20210103005003/en/Exact-Sciences-and-Guardant-Health-to-Offer-Blood-Based-Lung-Cancer-Assay-as-a-Supplement-to-LUNGER-Study-the-largest-prospective-core-biopsy-study-ever-for-the-diagnosis-of-lung-nodules-followed-in-clinical-practice%7B%7Blude_button|More?response=blank}}
3. https://www.prnewswire.com/in/news-releases/exact-sciences-and-cigna-agree-to-make-colon-cancer-screening-more-affordable-for-millions-of-americans-through-new-partnership-859496981.html

Dane Raynor

Hey there, I’m Dane Raynor, and I’m all about sharing fascinating knowledge, news, and hot topics. I’m passionate about learning and have a knack for simplifying complex ideas. Let’s explore together!