Overexposure to gastric acid causes cellular changes in the esophageal lining, and this can be a precursor to esophageal adenocarcinoma.

If you have Barrett’s esophagus, it is important to manage your condition with the help of a board-certified gastroenterologist. Less than one percent of patients with Barrett’s esophagus develop esophageal cancer, but cancer of the esophagus is aggressive and difficult to treat. For this reason, researchers are committed to learning more about how Barrett’s esophagus develops so they can diagnose it earlier.

A team of researchers from Columbia University Medical Center (CUMC) recently made an exciting discovery: the “cell of origin” for Barrett’s esophagus. Jianwen Que, M.D., Ph.D., associate professor of medicine at CUMC, and Ming Jiang, Ph.D., associate research scientist in CUMC's Department of Medicine, led the study. Using genetically altered mice that were predisposed to Barrett’s esophagus, the research team examined the gastroesophageal junction tissue for changes. The gastroesophageal junction is a specific place where the esophagus and stomach join, and this area is especially susceptible to GERD inflammation and damage.

Dr. Que and the team discovered an area of the gastroesophageal junction that had a high concentration of unique basal progenitor cells. These cells are similar to stem cells and can specialize into various types of specific cells.

Now that the team knows where to find the Barrett’s esophagus cell of origin, this new knowledge could streamline Barrett’s esophagus diagnoses. In the past 40 years, esophageal adenocarcinoma has increased by 800 percent, making it the fastest growing form of cancer in the United States. Early diagnosis and immediate intervention is imperative because esophageal cancer advances rapidly. Currently, only 20 percent of patients survive longer than 5 years after diagnosis (Source: Medical News Today). Improving Barrett’s esophagus detection and treatment could impact esophageal adenocarcinoma rates.

Instead of contributing your hard-earned dollars toward a healthcare network account which pays for thousands of people of varying degrees of health, you can invest that same money, tax-free, into your HSA for your own medical costs and even earn interest.

What is an upper endoscopy?

Monthly contributions to your HSA can help pay for necessary tests and procedures like an upper endoscopy. Also known as esophagogastroduodenoscopy (EGD), this procedure is used to determine the cause of gastrointestinal disorders and symptoms including:

• Acid reflux
• Gastroesophageal reflux disease (GERD)
• Heartburn
• Swallowing difficulties
• Upper abdominal pain

Why might you need an endoscopy?

An upper endoscopy is used to diagnose or treat conditions of the upper digestive tract. This procedure is performed by a gastroenterologist – a doctor who specializes in digestive conditions. Gastroenterologists perform upper endoscopies to:

• Investigate the cause of symptoms – Upper endoscopy can help determine the cause of nausea, vomiting, upper gastrointestinal bleeding, upper abdominal pain or difficulty swallowing.
• Diagnose conditions – Upper endoscopy can be used to confirm or rule out conditions of the upper digestive tract. Tissue samples may be sent to a lab for biopsy.
• Treat symptoms – Your gastroenterologist can use tools to perform procedures during upper endoscopy. This may include esophageal dilation, removal of polyps, removal of foreign objects or cauterization of blood vessels.

How much does an upper endoscopy cost?

There are many factors that can influence the cost of an upper endoscopy, so it is imperative that you do your homework beforehand. These factors include:

• Medical code — The cost of an upper endoscopy will be influenced by how the procedure is coded. Medical codes are used to describe diagnoses and treatments and help determine costs and reimbursements. Request the Current Procedural Terminology (CPT) code from the doctor who is ordering the test. You will need it later.
• Your doctor and facility of choice — Choosing an in-network gastroenterologist and an in-network facility will save you money. Also, consider having your procedure done at an ambulatory surgery center (ASC) because it is often less expensive than a hospital.
• Timing of your procedure — If you have not met your deductible, you will be responsible for the charges for the upper endoscopy. If you have already met your annual deductible, your insurance may cover the procedure, but you may still be responsible for some cost-sharing.

Questions to ask your insurance company before you schedule an upper endoscopy

Before scheduling an upper endoscopy, you should make a list of questions to ask your insurance provider to determine your financial responsibility. These questions include, but are not limited to:

1. My doctor has ordered an upper endoscopy for me. The CPT code is _______. Would you please tell me how close I am to reaching my annual deductible?
2. My doctor suggests that I have Dr. __________ perform my procedure. Is Dr. ___________ in-network and covered under my policy? What other gastroenterologists in my local area are part of my network? I would like to call them and price compare using the CPT code.
3. Is ______________ [your preferred hospital or ambulatory surgery center] in-network and covered under my policy?
4. I know that if a biopsy is needed, this will be an additional cost to me. What cost should I anticipate if this is needed? What other out-of-pocket costs should I inquire about when calling these gastroenterologists?

Shop around for the best price for your upper endoscopy

Now that you have this information, you can begin comparing costs among gastroenterologists and facilities in your area. Cost for an upper endoscopy can vary widely, even within a small radius, so take your time and call several providers. Make sure to look at physician ratings and reviews and make them an equally important component in your decision-making process. You may have to call your insurance company back and ask them additional questions before making your final choice. 

Use your HSA funds

Before you call your doctor of choice to schedule the upper endoscopy, look carefully at your HSA and verify that you have enough funds in your account to pay for the procedure. If you do not, you can speak to the billing office about a payment plan.

With some careful budgeting and planning, you can schedule your endoscopy knowing that you are getting quality care at the most reasonable price. HDHPs with HSA gives you flexibility and choice so you can make informed decisions about your healthcare.

Colonoscopy as the gold standard for colon screening

Certain preventive screenings are covered at 100 percent under HDHPs, and it is important that you take advantage of these privileges because they are an integral part of wellness and disease prevention. One of the most important preventive screenings is a colonoscopy, a test that can detect and prevent colon cancer. Colon cancer is the third leading cause of cancer death among men and women in the United States, and it is estimated that over 95,000 people will be diagnosed with the disease this year.

Although home stool tests can help detect cancer, colonoscopy is the gold standard for colon cancer screening because your doctor can view the entire length of the colon to evaluate the health of your digestive tract. If any polyps are discovered, your doctor can typically remove them during the procedure before they have the chance to develop into cancer.

How will I know when I should get a colonoscopy?

If you are at average risk for colon cancer, you should get your first screening colonoscopy at the age of 50. If you are African American, you should schedule your first colonoscopy at age 45. Having a family history of colon cancer or polyps or personal history of polyps also may lower the recommended age for your baseline colonoscopy, but you will need to talk to your doctor to determine your optimum age to be screened.

The difference between screening colonoscopies and diagnostic colonoscopies

There are two types of colonoscopy: screening and diagnostic. Screening colonoscopies are coded and covered differently than diagnostic colonoscopies. The amount an insurance provider will pay toward a colonoscopy depends on how the procedure is coded.

A screening colonoscopy is performed on an asymptomatic patient of screening age to examine for colon polyps or cancer. Your HDHP provider should cover screening colonoscopies as part of Affordable Care Act (ACA) preventive healthcare, but there are certain conditions that have to be met. You must choose an in-network gastroenterologist and an in-network hospital or facility such as an ambulatory surgery center (ASC). If you go out-of-network, you may be subject to cost sharing. Choosing an in-network doctor and facility can result in a difference of hundreds of dollars.

Before scheduling your screening colonoscopy, you should make a list of questions to ask your insurance provider to help determine your financial responsibility. Some of these questions should include, but are not limited to:

• I am _________ years old. Am I eligible for a screening colonoscopy under my current policy? NOTE: Most plans will offer colonoscopy benefits at 50 years of age. If you have a family history of colon cancer or polyps, you will have to provide the age of the first-degree relative at the time of diagnosis and ask for the information to be noted in your medical records.
• Is Dr. ______________ [your preferred physician] in-network and covered under my policy? What percentage of that doctor’s charges are covered?
• Is ______________ [your preferred hospital or ambulatory surgery center] in-network and covered under my policy? What percentage of the facility charges are covered?
• Will I have out-of-pocket costs for anesthesia? (some providers will waive deductibles and co-insurance for anesthesia costs, but you should ask your provider during this phone call).
• If the doctor finds that I have a colon polyp, will the pathology costs be covered?

Depending on your plan, most insurance companies pay for the actual screening procedure at 100 percent. However, there may be cost sharing for anesthesia or pathology charges. This depends entirely on your individual plan. Even if you have no personal or family history of colon cancer or polyps and this is your baseline colonoscopy, it is important to ask your provider about medical coverage if a polyp is found and needs to be removed.

A diagnostic colonoscopy is a procedure that is requested when symptoms are present or when another screening procedure comes back positive. In this case, you should expect to be responsible for the charges if you have not met your annual deductible. You should call your insurance company to inquire about coverage and out-of-pocket expenses. Ask your insurance provider the same questions listed above, but also request information about your financial responsibility for the procedure itself, as well as anesthesia and polyp removal (if required) and if you need further care.

Making informed choices with your HDHP

After you speak to your insurance provider, you should begin price comparing. Just as you would shop around before making any other large purchase, you should compare prices of doctors and facilities.  There is no standard cost for a colonoscopy, and you may find that several gastroenterologists in your area have widely varying costs. It is often more economical to have your colonoscopy performed at an ambulatory surgery center (ASC) because of their personal service, convenient access, shorter wait times and lower cost. By calling around to find low-cost, high-quality healthcare, you will be making informed decisions about how you spend your healthcare dollars.

Take the time to do some research so that you can make an informed decision. Whether you are making decisions about a health plan, doctor, facility or procedure, do your homework. A little bit of planning can make all the difference when the bill arrives.

In exchange for a higher deductible, the monthly premium is usually lower, but you pay healthcare costs out-of-pocket before your insurance company starts to pay.

HDHP vs. PPO and HMO

Traditional PPOs and HMOs are expensive for employers as well as employees. The Institute of Medicine estimates that 30 percent of health spending is waste. HDHPs are designed to reduce unnecessary healthcare spending and encourage consumers to take an active role in managing their own healthcare costs. Instead of paying high premiums for benefits you might never use, an HDHP allows you to decide how you want to spend your healthcare dollars.

Additionally, HDHPs can be combined with some form of savings option to allow you to set aside pretax dollars for out-of-pocket health care expenses. The savings options take several forms, including tax-free individual health savings accounts (HSAs) and employer-sponsored Health Reimbursement Arrangements (HRAs). The combination of an HDHP and a tax-free savings account is known as a consumer directed health plan (CDHP).

How HDHPs Save You Money

If you are in good health, like the idea of low monthly premiums, and plan to use your insurance for routine preventive screenings, an HDHP can help maximize your healthcare dollars. HDHPs encourage healthy living, routine preventive care, and comparison shopping for high-quality, low-cost medical services.

Because you are paying upfront for covered medical expenses, you will be charged a lower, negotiated rate between the healthcare provider and the insurance company. Preventive services like vaccinations, colonoscopies, mammograms and flu shots are covered at 100 percent, so there is no need to budget for these services. Since you are directing your own healthcare spending, you will likely make healthier lifestyle choices that will lower your risk for chronic conditions and expensive medical procedures.

How do HDHPs Work? Take the Time to Learn

Although HDHPs have spiked in popularity over a short period of time, there is a general lack of understanding about them. Also, many people feel uneasy about switching to an HDHP until they learn that HDHPs can offer consumers more flexibility and control over their own healthcare costs.

If your employer is offering an HDHP, take some time to familiarize yourself with the details. This healthcare plan may work differently than any of your previous plans. It will take some time to get used to paying out-of-pocket for doctor visits and prescriptions until you reach your deductible. It is important to invest the money you would have spent on higher monthly premiums in your HSA or other tax-free savings account. This requires discipline and planning, but it will soon become a habit.

Take ownership of your medical care and get informed.  Whether you selected an HDHP or the decision was made for you, see this as an opportunity to take initiative in your healthcare. You may find that the traditional PPO you have always chosen may not be the best use of your money.

Not all HDHPs are created equally, so contact your human resources department or benefits coordinator for more information about your HDHP. You may want to ask for literature or video tutorials so you can share the features of your HDHP and HSA with your spouse or partner. The more you learn about your new healthcare coverage, the more adept you will be at making cost-conscious, informed decisions about your medical care.