QualityPath Benefit Details: Colonoscopies

Providers:

View list of providers performing colonoscopies.

Notification requirements:

You must notify The Alliance before your colonoscopy appointment for you to receive the QualityPath level of benefits. You may notify us in one of these ways:

  • Complete the online Tell Us form here. (Schedule the appointment with the QualityPath provider before completing the form.)
  • Send us the completed form available for download here (coming soon).
  • Call The Alliance Patient Experience Manager at 800.223.4139 x6607. (Call us if you have questions or if you need help scheduling your appointment.)

You must notify The Alliance before your pre-operative visit for it to be covered at QualityPath level of benefits. (Note – most patients are not required by the colonoscopy provider to have a pre-operative visit.)

Services covered at the QualityPath level of benefits:

  • Pre-operative visit
  • Facility (clinic or hospital) charge
  • Surgeon’s fee
  • Anesthesia
  • Pathology
  • Post-procedure care from the surgeon for up to 7 days after the procedure, including:
    • Follow-up visits
    • Pain management

NOTE: please see warranty for information regarding complications.

Warranty:

The Alliance must be notified of possible warranty services no later than 14 days after the date of the colonoscopy. Call 800.223.4139 x6607 if you have services that may apply to the warranty.

Services under the warranty are covered under the QualityPath level of benefits.  The warranty covers the following care related to the QualityPath colonoscopy:

  • Incomplete procedures including those halted due to poor preparation.
  • Emergent, urgent or inpatient care for up to 7 days following original procedure for gastrointestinal bleeding, abdominal pain and perforation.

Exclusions:

The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.

  • Pre-operative lab work
  • Prep medications
  • Inpatient or emergency colonoscopies
  • Pediatric colonoscopies
  • Colonoscopies performed for reasons other than colorectal cancer screening or surveillance
  • Colonoscopies that are not the primary purpose of the visit
  • All services provided by a non-QualityPathprovider
  • Post-procedure care that:
    • is unrelated to the colonoscopy
    • is not covered by the warranty
    • occurs more than 7 days after the colonoscopy
  • Pre-op visits or colonoscopies performed prior to The Alliance receiving notification of the appointments.

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