Introduction
Colonoscopy is an important diagnostic tool in the prevention of colon cancer. In the following, the costs for patients with statutory and private health insurance are discussed. You can find information about the procedure of a colonoscopy here: Procedure of a colonoscopy
Costs of the statutory health insurance funds
Colonoscopy is paid for by the statutory health insurance companies from the age of 55 as part of cancer screening. If the colonoscopy is negative – i.e. the doctor performing it does not notice any changes or pathological processes – the colonoscopy can be performed again 10 years later. Under normal circumstances, an outpatient colonoscopy is paid for by the statutory health insurance companies.
This means that the patient only comes to the practice for a colonoscopy. The preparation for the colonoscopy, such as drinking the laxative, is done by the patient himself at home. An in-patient colonoscopy is not paid for by the statutory health insurance companies if there are no special indications.
Possible indications for an inpatient colonoscopy are, for example, if the patient is not able to drink the laxative on his/her own or if the preparation has to take place under observation due to other previous illnesses. In principle, the general practitioner can make the indication for an in-patient colonoscopy. For persons under 55 years of age, colonoscopy is not paid for under all circumstances.
In this case, the indication for a colonoscopy must be given by the family doctor; if this does not happen, the costs for the treatment must be paid by the patient himself. If there are known cases of colorectal cancer in the family, this is a clear indication for a colonoscopy, the costs of which are then covered by the health insurance companies. If the patient has symptoms that could indicate diseases of the intestinal tract, such as chronic intestinal diseases (e.g. Crohn’s disease or ulcerative colitis) or colon cancer, then this is also an indication for a colonoscopy.
Patients should report their symptoms to their family doctor, who can then make a referral to a specialist in gastroenterology. If there is a bowel disease, a colonoscopy should be performed every 1 – 2 years. In this case, the costs are covered by the health insurance companies, as in this case, too, the colonoscopy is performed with good reason – namely for monitoring the progress of the disease and for possible interventions, such as the removal of polyps.
Costs of private health insurance companies
For persons who are privately insured, the same applies as for persons with statutory health insurance, that if a doctor considers colonoscopy to be important, the costs are covered by the private health insurance. There is no uniform standard for colonoscopy for cancer screening from the age of 55 onwards with private health insurance companies. The private health insurances are not bound to the legally prescribed service catalogue for the statutory health insurances.
Whether or not colonoscopy is covered should therefore be determined by contacting the private health insurance company before the examination. In the course of the basic tariffs of the private health insurance companies, however, it is regulated by law that the standard services must correspond to those of the statutory health insurance companies, which means that the private health insurance companies must basically offer all the services that the statutory health insurance companies also provide. This means that colorectal cancer screening must be offered from the age of 55.
However, as there may be deviations in the exact services offered by private health insurance companies, such as the time from which screening is offered, it is still advisable to inquire with the respective health insurance company in advance as to the extent to which the costs of colonoscopy will be covered at the respective time. If you as a patient have a colonoscopy performed in a specialized clinic, it is possible that you will be asked to sign a private treatment contract. In this case, the treating clinic may charge for other and above all more expensive treatments. These are not covered by the insurance companies and in this case have to be paid by the patients themselves.
