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Insurance Carrier: Cigna
State: Missouri

Consumer Complaint:

My doctor ordered a colonoscopy due to my mother dying of colon cancer at the age of 61. I thought this would be covered under my health insurance since they cover mammograms and pap smears. I spoke to the Cigna customer service and was told they do not cover elective colonoscopies. I read in our local newspaper that the state of Missouri requires insurance to cover cancer screenings. Is this something that Cigna does not have to cover? I am not sure I would have had this test done if I had known they wouldn't cover it. This was a cost of $1700.00


Insurance Expert Answer:

IF the insurance plan was provided by a private employer, it is almost certainly exempted from state insurance regulation by ERISA, a Federal Law adopted in 1974 that "preempts" all state insurance laws on employer provided plans. Your best bet is to have the doctor describe why the colonoscopy was medically required, rather than an optional elective. The second approach is to get the doctor to accept what the insurance company would have paid under its negotiated rate. That's really what the "reasonable and customary" rate is, not the "rack rate" s/he bills you for.