1. Preparation
WHAT IS A COLONOSCOPY?
The colon, or large intestine, is a hollow tube, about five feet long, and its main function is to store unabsorbed food products prior to their elimination. The term “colonoscopy” means looking inside the colon. This is done by inserting a flexible fiberoptic scope into the colon via the anus. Your doctor is able to visualise the colon on a video screen, and may also insert very small instruments through the scope in order to do minor things such as take biopsies.
WHY IS IT DONE?
Colonoscopy is a safe and effective way to evaluate symptoms such as blood loss, pain, and changes in bowel habits. It may also be used to further investigate abnormalities identified during other tests. Colonoscopy can also identify and treat active bleeding from the bowel.
In some cases, such as when there is a strong family history, a personal history, or other high risk factors for colon cancer, it is recommended that people undergo screening colonoscopies to check for problems.
If your doctor identifies the presence of Colon polyps, these may be removed during the colonoscopy procedure. Colon polyps are abnormal growths on the inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into cancer.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a gastroenterologist who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Gastroenterological Society of Australia via their website at www.gesa.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)
To access a list of Gastroenterologists who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the planned procedure; do not be afraid to ask.
-
What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent. Your doctor will ask you to sign a consent form, which you should fully understand.
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
WHERE IS IT DONE?
Colonoscopy can be done in either a day surgery or in the day facility of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The time needed for a colonoscopy will vary, but on average, the procedure takes about 30 minutes.
WHO IS INVOLVED?
The procedure is usually carried out as a Day Surgery Patient in a specialised day surgery or in a Hospital. The people involved in the procedure are:
-
The Gastroenterologist, your Specialist doctor
-
Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Specialised Nurses for the procedure and recovery
-
Radiologist if any x-rays are necessary
-
Pathologist if any blood tests are necessary
HOW DO I PREPARE FOR A COLONOSCOPY?
If the procedure is to be complete and accurate, the colon must be completely clean. You will be given detailed instructions about the cleansing of the colon. Various methods can be used but in general, a liquid preparation designed to stimulate bowel movements is given by mouth, which may cause bloating. Sometimes laxatives or enemas are prescribed prior to the examination.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated later. A less accurate alternative may be chosen in its place, such as an x-ray or Barium enema.
You will also have to fast for at least 6 hours prior to the procedure. Please follow any instructions given to you by the Day Surgery/ Hospital and your doctor.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
It’s best not to wear any jewellery (sometimes plain bands are acceptable)
-
Wear comfortable clothing
-
Take any recent, relevant x-rays or scans
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
You may also wish to bring something to read whilst you wait
-
Remove all nail polish and do not wear any make-up
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Colonoscopy admissions for the financial year 09/10 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$681
|
$0
|
$682
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$319
|
$131
|
$168
|
$195
|
10.3%
|
$0
|
89.7%
|
|
Colorectal Surgical Services
|
$495
|
$267
|
$190
|
$300
|
12.2%
|
$0
|
87.8%
|
|
Pathology Services
|
$194
|
$117
|
$74
|
$103
|
2.5%
|
$0
|
97.5%
|
|
Specialist Consultation
|
$108
|
$63
|
$44
|
$37
|
1.7%
|
$0
|
98.3%
|
|
2
Total Average Medical Services
|
$931
|
$471
|
$402
|
$309
|
18.1%
|
$0
|
81.9%
|
|
Hospital and Medical Services Average for Colonoscopy Admissions
|
$1,612
|
$471
|
$1,084
|
$309
|
18.1%
|
$0
|
5
81.9%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 32,659 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 32090 and 32093.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e.you may not have all of these medical services, and/or you may also have other medicalservices not indicated here e.g. diagnostic procedures. Therefore, the total averagemedical service charge ($931) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all colonoscopies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medications you are taking and any allergies that you may have. Remember to mention any herbal or homeopathic remedies you may be taking, as these can have interactions and side effects too.
At some stage before the procedure, your specialist will ask you to sign a consent form indicating that you give him or her permission the procedure, and you understand all potential risks and complications.
Once this admission procedure is completed, usually you will then be taken to the procedure room. An anaesthetist may see you during this time. Once there, a plastic tube called a cannula is placed in your vein and is used to give medication to make you relaxed and drowsy. An intravenous drip may also be attached to the cannula, in order to replace fluids that were lost during the bowel preparation.
WHAT CAN I EXPECT DURING A COLONOSCOPY?
During the procedure, everything will be done to ensure your comfort.
As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort.
During the course of the procedure medical and nursing staff will monitor your heart rate, blood pressure, and oxygenation of the blood. If needed, you may receive additional doses of medication during the procedure.
If anything abnormal is seen in your colon, like a polyp or inflamed tissue, the doctor can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the doctor can pass a laser, heater probe, or electrical probe, or can inject special medicines through the scope and use it to stop the bleeding.
3. Aftercare
WHAT HAPPENS AFTER A COLONOSCOPY?
In the recovery area you will be asked to rest for an hour or two until the effects of the sedatives/anaesthetic have worn off. At this time, your doctor may talk to you about his findings, and provide any additional information that you need to know. You will also be given instructions about how soon you can eat and drink, plus other guidelines for resuming your normal routine.
Occasionally you may experience some minor side effects after you return home, like bloating, discomfort or occasionally light bleeding. You should receive specific instructions concerning any side effects you can expect to experience once home, and any symptoms for which you should seek further assistance
Though most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your colonoscopy. It’s common to feel a little light headed or forgetful after your sedation, especially as you won’t have eaten for some time. You should therefore arrange for a friend or relative to accompany you when you leave and, if possible, to remain with you overnight. If you find this difficult please inform the staff prior to admission.
1. Preparation
WHAT IS A COLONOSCOPY?
The colon, or large intestine, is a hollow tube, about five feet long, and its main function is to store unabsorbed food products prior to their elimination. The term “colonoscopy” means looking inside the colon. This is done by inserting a flexible fiberoptic scope into the colon via the anus. Your doctor is able to visualise the colon on a video screen, and may also insert very small instruments through the scope in order to do minor things such as take biopsies.
WHY IS IT DONE?
Colonoscopy is a safe and effective way to evaluate symptoms such as blood loss, pain, and changes in bowel habits. It may also be used to further investigate abnormalities identified during other tests. Colonoscopy can also identify and treat active bleeding from the bowel.
In some cases, such as when there is a strong family history, a personal history, or other high risk factors for colon cancer, it is recommended that people undergo screening colonoscopies to check for problems.
If your doctor identifies the presence of Colon polyps, these may be removed during the colonoscopy procedure. Colon polyps are abnormal growths on the inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into cancer.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a gastroenterologist who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Gastroenterological Society of Australia via their website www.gesa.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)
To access a list of Gastroenterologists who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the planned procedure; do not be afraid to ask.
-
It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form, which you should fully understand.
-
In addition to what the procedure involves, you should also ask about:
-
Most medications should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medications you should stop. As a guide, the following medications may require special instruction:
WHERE IS IT DONE?
Colonoscopy can be done in either a day surgery or in the day facility of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The time needed for a colonoscopy will vary, but on average, the procedure takes about 30 minutes.
WHO IS INVOLVED?
The procedure is usually carried out as a Day Surgery Patient in a specialised day surgery or in a Hospital. The people involved in the procedure are:
-
The Gastroenterologist, your Specialist doctor
-
Anaesthetist: they give you medications that make you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Specialised Nurses for the procedure and recovery
-
Radiologist if any x-rays are necessary
-
Pathologist if any blood tests are necessary
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Colonoscopy admissions for the financial year 09/10 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$681
|
$0
|
$682
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$319
|
$131
|
$168
|
$195
|
10.3%
|
$0
|
89.7%
|
|
Colorectal Surgical Services
|
$495
|
$267
|
$190
|
$300
|
12.2%
|
$0
|
87.8%
|
|
Pathology Services
|
$194
|
$117
|
$74
|
$103
|
2.5%
|
$0
|
97.5%
|
|
Specialist Consultation
|
$108
|
$63
|
$44
|
$37
|
1.7%
|
$0
|
98.3%
|
|
2
Total Average Medical Services
|
$931
|
$471
|
$402
|
$309
|
18.1%
|
$0
|
81.9%
|
|
Hospital and Medical Services Average for Colonoscopy Admissions
|
$1,612
|
$471
|
$1,084
|
$309
|
18.1%
|
$0
|
5
81.9%
|
Points to Note:
- Charges are based on HCF claims for a sample size of 32,659 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 32090 and 32093.
- As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
- There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($931) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all colonoscopies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
HOW DO I PREPARE FOR A COLONOSCOPY?
If the procedure is to be complete and accurate, the colon must be completely clean. You will be given detailed instructions about the cleansing of the colon procedure. Various methods can be used but in general, a liquid preparation designed to stimulate bowel movements is given by mouth, which may cause bloating. Sometimes laxatives or enemas are prescribed prior to the examination.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated later. A less accurate alternative may be chosen in its place, such as an x-ray or Barium enema.
You will also have to fast for at least 6 hours prior to the procedure. Please follow any instructions given to you by the Day Surgery/ Hospital and your doctor.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
It’s best not to wear any jewellery (sometimes plain bands are acceptable)
-
Wear comfortable clothing
-
Take any recent, relevant x-rays or scans
-
Bring any medications that you would usually take during the day, under most circumstances you may still be able to take these
-
You may also wish to bring something to read whilst you wait
-
Remove all nail polish and do not wear any make-up
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medications you are taking and any allergies that you may have. Remember to mention any herbal or homeopathic remedies you may be taking, as these can have interactions and side effects too.
At some stage before the procedure, your specialist will ask you to sign a consent form indicating that you give him or her permission the procedure, and you understand all potential risks and complications.
Once this admission procedure is completed, usually you will then be taken to the procedure room. An anaesthetist may see you during this time. Once there, a plastic tube called a cannula is placed in your vein and is used to give medication to make you relaxed and drowsy. An intravenous drip may also be attached to the cannula, in order to replace fluids that were lost during the bowel preparation.
WHAT CAN I EXPECT DURING A COLONOSCOPY?
During the procedure, everything will be done to ensure your comfort.
As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is little or no discomfort.
During the course of the procedure medical and nursing staff will monitor your heart rate, blood pressure, and oxygenation of the blood. If needed, you may receive additional doses of medication during the procedure.
If anything abnormal is seen in your colon, like a polyp or inflamed tissue, the doctor can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the doctor can pass a laser, heater probe, or electrical probe, or can inject special medicines through the scope and use it to stop the bleeding.
3. Aftercare
WHAT HAPPENS AFTER A COLONOSCOPY?
In the recovery area you will be asked to rest for an hour or two until the effects of the sedatives/anaesthetic have worn off. At this time, your doctor may talk to you about his findings, and provide any additional information that you need to know. You will also be given instructions about how soon you can eat and drink, plus other guidelines for resuming your normal routine.
Occasionally you may experience some minor side effects after you return home, like bloating, discomfort or occasionally light bleeding. You should receive specific instructions concerning any side effects you can expect to experience once home, and any symptoms for which you should seek further assistance.
Though most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your colonoscopy. It’s common to feel a little light headed or forgetful after your sedation, especially as you won’t have eaten for some time. You should therefore arrange for a friend or relative to accompany you when you leave and, if possible, to remain with you overnight. If you find this difficult please inform the staff prior to admission.