How do I ask my insurance company about coverage for Cologuard?
We highly recommend that you 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”
- Ask these things:
- Does my plan cover the Cologuard test? This service is billed under CPT code 81528. Is Exact Sciences Laboratories a particpating in-network provider for my plan?
- Do I have Preventive Care Services and colon cancer screening included in my benefit plan? Is Cologuard an approved CRC screening option for me?
- Is a prior authorization, statement of medical necessity, or any other documentation required from my healthcare provider? If yes, what information is needed?
- What is my cost share for this service? Will I have any additional financial responsibility?
Obtain a statement of medical necessity to share with your healthcare provider by visiting CologuardTest.com/medicalnecessity.
- If you find out that Exact Sciences is out-of-network or that your plan doesn't cover Cologuard specifically, ask these additional questions:
- Do I have out-of-network benefits and what will my financial responsibility be?
- If Cologuard is not a covered benefit, how do I appeal this decision? What information does my healthcare provider or I need to provide?
- How long will it take my healthcare provider or I to hear from you?
Get help writing an appeal letter at CologuardTest.com/appeal.