Digestive or gastrointestinal problems are quite common. Over 74 percent of Americans are currently living with conditions related to their digestive system. Problems such as heartburn, indigestion, belly bloating or pain, excessive burping, and vomiting sends thousands of people to their health care providers every year in the United States.
Luckily, physicians have access to valuable diagnostic tools which help them determine the problem and allow them to choose the right treatment for each individual case. If you have been experiencing gastrointestinal distress or discomfort, your health care provider may order an upper GI exam to get a diagnosis.
There are different types of upper GI exams that your doctor may order for you depending on your condition. The barium swallow is an x-ray exam of the esophagus. An upper GI series of x-rays concentrate on the stomach, and a small bowel series are x-rays that examine the duodenum which is the beginning portion of the small bowel linked to the stomach. An endoscopy is another tool that doctors use to examine the digestive tract.
Living with pain or discomfort in your gastrointestinal tract is not necessary if your health care provider can find the reason behind it. Having an upper GI examination is not difficult or time consuming, but do you have Medicare coverage to help with the expense? Here are some of the facts.
Does Medicare Insurance Pay for Upper GI Exams?
Because upper GI examinations are categorized by Medicare as diagnostic non-laboratory tests, your Medicare Part B (medical insurance) policy may cover 80 percent of the cost.
In order to be eligible for coverage under Medicare Part B, your health care provider must certify that the exam is medically necessary. You must receive care from a physician that accepts Medicare assignment, and the hospital or clinic where you have your tests done must also accept Medicare assignment.
With Medicare coverage under Part B, Medicare generally pays for 80 percent of the costs, and you pay the remaining 20 percent. You are also responsible for your Part B deductible. If you have supplemental Medicare insurance through Medigap Plan F, G, or N, it may help pay the 20 percent.
Types of Upper GI Exams
Your health care provider may suggest an upper GI examination if you have one or more of the following symptoms:
• Difficulty swallowing
• Abdominal or stomach pain
• Unexplained weight loss
• Unexplained bleeding
• Unexplained vomiting
• Acid reflux, heartburn, indigestion
• Hernia
An upper GI series examines the esophagus, stomach, and portion of the small intestine. As your health care provider examines you, you drink a barium solution. The physician holds a fluoroscope over your body, and this transmits images to a video screen as the barium travels through the digestive tract. This exam is called a barium swallow exam.
Depending on your circumstances, your physician may suggest that you have an upper endoscopy. This exam is done in a hospital or clinic on an outpatient basis. You may have a mild sedative for this exam. During an endoscopy the doctor inserts a flexible tube with a camera on the end into your esophagus. The camera transmits an image to a screen allowing the physician to see what is going on in the digestive tract.
These tests help doctors diagnose some of the common conditions related to gastrointestinal problems such as:
• Hiatal hernia
• Stomach ulcers
• Tumors
• Diverticulitis
• Esophageal varices, obstructions, and narrowing
• Enteritis
Getting an Upper GI Examination with Medicare Insurance
Having Medicare Part B coverage means you only have to pay for a portion of the cost for upper GI exams. If you have a Medicare Advantage policy, you may have complete coverage, but it depends on your insurance provider and the policy you have.
Without insurance coverage, the average cost for a barium swallow exam is between $300.00 and $450.00 in the United States. If you have an upper endoscopy, you pay between $1,200.00 and $3,200.00 depending on where you have the procedure done, the type of procedure, and who performs it.
If you are concerned about whether your Medicare benefits cover upper GI examinations, you can get more information from your plan directly.
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