Abstract B82: Employer-based health insurance coverage of colorectal cancer screening in Appalacian Ohio

Background: Residents of Appalachia are considered medically underserved and are burdened by increased mortality from colorectal cancer (CRC).

Purpose: This study sought to evaluate the nature of employer-based insurance coverage for CRC screening in Appalachian Ohio, with an emphasis on coverage for colonoscopy.

Methods: The population of all employers in Perry, Morgan, and Muskingum counties (n=145) were selected for a telephone survey asking about their insurance benefit. Of particular interest was the inclusion of colorectal cancer screening in the employer's explanation of benefits, the kinds of colorectal cancer screening covered by insurance plans (such as fecal occult blood test (FOBT), flexible sigmoidoscopy (FlexSig), colonoscopy, and dual contrast barium enema (DCBE)), and the existence of programs within the workplace to encourage colorectal cancer screening. The survey response rate was 25.5 % (n=37).

Results: Ninety-seven percent of respondent employers (n=36) indicated that they did provide some level of insurance coverage for employees. Several employers who chose not to respond indicated that they either did not have a benefits representative who was knowledgeable about the details of the insurance plan, or did not feel comfortable reporting about their insurance benefit. More specifically, 24.3 % (n=9) of respondent businesses did not know if any form of CRC screening was covered. However, among respondent employers, plans included coverage for colonoscopy 70.3% of the time (n=26), and required a co-pay 59.4 % of the time (n=22).

Other methods of CRC screening (FOBT, FlexSig, and DCBE) were also covered by 70.3% of respondents (n=26) with a co-pay required in 59.4% (n=22). Across employers, only 10.8 % (n=4) of responding employers indicated that their insurance plan's formal explanation of benefits mentioned coverage for CRC screening. Only 8 % (n=3) of respondents reported programs in the workplace which encouraged CRC screening.

Implications: Although there is a high rate of CRC screening coverage in the sample, it is possible that those not responding did not provide adequate coverage for CRC screening. Future outreach efforts should address and advocate for employer benefit coverage of CRC screening along with increased workplace programming to promote awareness and use of CRC screening insurance benefits.