U-M doctors fight to make more cancer screenings & follow-ups free for everyone

Posted at 1:33 PM, Jan 10, 2023

In the fight against cancer, early intervention is key, and that means regular screenings are vital.

Colon cancer is the second-leading cause of cancer deaths in America, claiming 52,000 lives a year.

Current guidelines suggest routine colon cancer screening starting at age 45. It can be an at-home stool test or a colonoscopy.

If you're in the clear, from there, you can get one every 10 years, but some screenings require a closer look.

The problem, the cost has been a barrier. But, with the start of 2023, millions of Americans now have free access to vital cancer care.

It's thanks to a fight led in part by University of Michigan researchers, and now, they're pushing to expand access to millions more.

"I've had polyps from time to time. So every 3 to 5 years they asked me to come back," Dr. Nathaniel Pernick said.

Under the Affordable Care Act, cancer screenings are supposed to be free. So, Pernick was surprised to receive a bill for $879 from a colonoscopy in May. He wrote the hospital, his health insurance company, and the state, and ultimately they removed the charge.

"But it took many, many letters and 3 to 4 months for that to happen," he said.

To help others, he took to social media to explain that while screenings are free, follow-up colonoscopies billed as diagnostic may not be. Until now.

To help others Dr. Pernick took to social media to explain that while screenings are free but follow-up colonoscopies billed as diagnostic may not be. That is until now.

"Almost all insured Michiganders will be able to get their follow-up colonoscopy at no cost to them," Dr. A. Mark Fendrick said. He's with the University of Michigan Center for Value-Based Insurance Design.

Fendrick and the center were leaders in the fight to extend coverage to include follow-up diagnostic colonoscopies.

Fendrick’s research shows even small costs can deter the use of all kinds of cancer screenings. He hopes the federal rule requiring no-cost colon cancer screenings and covering follow-up colonoscopies will save lives.

"Americans are very price sensitive to healthcare services," he said.

The rule doesn't cover diagnostic costs for breast, lung and cervical cancer. NoW, Fendrick and his colleagues are pushing for similar coverage for millions of Americans.

"People who are going to make decisions that they have to pay rent or pay for gas or have to feed their family with more nutritious food, than go on to get these follow-up tests," he said.

It was a ten-year fight but Fendrick says they now have a playbook.

As forPernick, he says he’s lucky. He can afford to pay the bill he received but pushed back and shared his strategy to help others who can’t afford to pay.

"We have a responsibility to try to make the world a better place. And this is one way to do it, to use my knowledge to help other people," he said.

Both doctors agree there are very few interventions that save lives and save money, but cancer screening and early intervention do just.

Identifying cancers in the early stage means they are more treatable, and treating cancer early is cheaper than treating it at more advanced stages.

That can lower healthcare costs for all of us.