How do I ask my insurance company about coverage for Cologuard?

If you’re planning to call your insurer to ask whether your plan covers Cologuard, here are some useful things you can tell them: 

Before You Call

  • Look at the back of your insurance card to find the customer service or member services phone number.
  • Be ready to give your full name, date of birth, and member ID number (on front of card)

During Your Call

  • Follow the prompts for “benefits” or “coverage”
  • Tell the representative these things about Cologuard:
    • It’s a colorectal cancer screening test
    • It’s billed under CPT 81528
    • It should be under my preventive care benefits or lab benefits
    • The test is performed by Exact Sciences Laboratories in Madison, WI (TIN# is 46-3095174)
  • Ask these things:
    • Is Exact Sciences Laboratories considered in-network for my plan?
    • If not, how are out-of-network services reimbursed by my plan?
    • What are my out-of-pocket costs for this test?
    • Does my plan require preauthorization from my doctor?
    • Can you make a coverage exception since my provider ordered this test and Exact Sciences is the only provider that can perform this test?