Colorectal HealthDigestive SystemInsurance and Payment Information

Colorectal Health

What is colorectal cancer?

Cancer affecting the colon and rectum is a serious but very preventable disease. According to the American Cancer Society, colorectal cancer is the third most common type of cancer in both men and women and the second leading cause of cancer deaths in the United States. The good news is that the American Cancer Society has reported a decreased death rate from colorectal cancer over the last 20 years. Two of the most likely reasons for this decline are direct results of screenings. Screenings find and remove polyps before they develop into cancer. In addition, screenings can detect cancer in its early stages when it is easier to cure. For more information, visit the American Cancer Society’s website.

Visit the American Cancer Society’s website

Why should I be screened or tested?

Since polyps and early stages of colorectal cancer typically do not manifest symptoms, it is important to be screened. In most cases the development of colorectal cancer begins with a polyp: a small, wart-like or mole-like growth on the inner lining of the colon. The benefit of screening is that while Dr. Stout is looking for polyps, he can remove them before they turn into cancer.

Polyps vary in type and importance. To the eye they may appear the same; the only way to differentiate among them is to remove and observe them under a microscope. Fortunately, this is fairly easy to do during a colonoscopy without any discomfort to the patient. If a pre-cancerous polyp is left in place or remains undetected, there is a risk that with time it will grow and gradually transform into a cancerous tumor. Even at this stage, there may be no particular symptoms to call attention to it as there are no early symptoms of colorectal cancer. When symptoms appear the cancer is typically more advanced and difficult to treat.

Polyps can occur at any age, but for most people without a personal or family history of polyps or colorectal cancer, the chance of developing polyps increases at age 45 and older. Colorectal cancer can be prevented and is one of the most treatable types of cancer when detected early.

How can I be screened for colorectal cancer?

The most effective screening method is with a procedure called a colonoscopy. A colonoscopy is the gold standard test in the medical profession for colorectal cancer screening and prevention due to the test’s accuracy and completeness. A colonoscopy is a procedure by which the rectum and length of the colon are examined with a flexible, tubular instrument called a colonoscope. The colonoscope has a tiny camera and light on the end which is connected to a large monitor that allows the doctor to carefully view and inspect the entire colon. In a majority of cases, if the doctor detects an abnormality or identifies a polyp, he can take a tissue sample of the abnormality or completely remove the polyp during the same procedure. The procedure takes less than half an hour to complete, with a total time commitment of about 1-2 hours.

If you are 45 or over, or if you have a family history of colon or rectal cancer, talk to your doctor about a screening colonoscopy. Recommendations are typically tailored to the individual patient and include considerations such as the patient’s past medical and surgical history, age, and family history of other diseases. Your health insurance company can tell you if screening colonoscopies are a covered benefit under your policy.

What is my risk for colorectal cancer?

Risk factors for colorectal cancer include things such as:

  • Age
  • Personal or family history of colon polyps
  • Personal or family history of colon cancer
  • Lifestyle habits such as diet, tobacco use, alcohol use, and exercise frequency
  • Racial and ethnic background
  • Other chronic diseases

The bottom line is that risk exists. It is essential that you are screened regularly if you are over 45, and earlier if you have a family history of colorectal cancer. The key to surviving this disease is early detection. In fact, the American Cancer Society released new guidelines in 2018 recommending that average-risk adults be screened for colon cancer earlier, at age 45 instead of 50. Click here for more info.

Learn more at the American Cancer Society’s website.

What are colorectal cancer warning signs?

Although polyps and the early stages of colorectal cancer usually present no symptoms, there are warning signs that indicate you may need to be examined. Some symptoms to watch for are:

  • A change in bowel habits
  • Either diarrhea or constipation
  • Blood in the stool (bright red, black or very dark)
  • Narrowed stools (about the thickness of a pencil)
  • Bloating, fullness or abdominal cramps
  • A feeling that the bowel does not empty completely
  • Frequent gas pains
  • Weight loss without dieting
  • Continuing fatigue
  • Unexplained anemia
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Insurance and Payment Information

We strongly encourage you to check your coverage by calling your insurance company directly before any procedure is performed to find out what your benefits are and if you may have any out-of-pocket expenses for your procedure.

How are services billed?

For a consultation with Dr. Stout, you will receive a bill from Gastroenterology of Indianapolis.
For a procedure, you will receive two separate bills from Gastroenterology of Indianapolis: one for the procedure performed by Dr. Stout, and one for the facility fee at Digestive Health Center.
If Dr. Stout orders any blood tests or stool studies, these will be sent to a clinical laboratory and you will receive a separate bill directly from the clinical laboratory.
Similarly, if Dr. Stout takes any tissue samples, these specimens will be sent to a pathology company and you will receive a separate bill directly from the pathology company.
Digestive Health Center is an ambulatory surgical center.

What is the difference between a Screening Colonoscopy and a Diagnostic Colonoscopy?

In the most general terms, a screening colonoscopy is typically performed in the absence of symptoms while a diagnostic colonoscopy is performed because of symptoms; however, it is very important that you understand how your insurance company differentiates between the two types of procedures. The definition and benefits provided vary from insurance company to insurance company and from policy to policy. We are unable to check your insurance company’s definitions as well as your specific coverage regarding screening benefits, diagnostic/therapeutic benefits, in-network benefits, or out-of-network benefits. This is your responsibility.

Some considerations that your insurance company may use to determine benefits are:

  • Gastrointestinal symptoms, either past or present, such as diarrhea, constipation, rectal bleeding, iron deficiency, anemia, or abnormal test results
  • Age of patient
  • Frequency of colonoscopy procedures
  • Personal and/or family history such as GI disease, colon polyps, cancer, etc.

Please understand that benefits vary depending on your specific scenario. If you come in for a screening colonoscopy (meaning you have no symptoms) and a biopsy is taken or a polyp is removed, your screening may become a diagnostic colonoscopy since the procedure code changes to reflect the biopsy or polyp. Insurance companies have varied responses to this situation, and your insurance may process the claim differently. Be certain to know your specific benefits in advance of your procedure.

Are you in-network with my insurance?

Dr. Stout and Digestive Health Center are in-network with many insurance companies. Below is a list of some of the insurances companies we participate with.

  • Aetna
  • Anthem/Blue Cross Blue Shield
  • Advantage Health Solutions
  • Cigna
  • Encore
  • Golden Rule
  • Humana PPO
  • Medicare*
  • Sagamore
  • SIHO
  • Tricare/Tricare for Life (authorization via PCP may be required)
  • UMR
  • United Health Care*

* We are not in-network with the specific AARP Medicare Complete plans provided through United Health Care.

Insurance companies may change in-network or out-of-network statuses at their discretion. Please check with them directly to verify the status prior to your procedure.

Do you accept Medicaid?

We are not in-network with any Medicaid plans including, but not limited to, Hoosier Healthwise, HIP, Care Select, and MDWise.

Can the physician change, add to or delete my diagnosis so that I can be considered eligible for a preventive colonoscopy screening?

NO! The patient encounter is documented as a medical record from information you have provided during the pre-procedure history and assessment as well as from the procedure itself. Please understand that strict government and insurance company documentation and coding guidelines prevent a physician from altering a chart for the sole purpose of coverage determination. Your medical record is a binding legal document that cannot be changed to facilitate better insurance coverage. To do so would perpetrate insurance fraud.

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