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Off Topic :
Colonoscopy and insurance coverage

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 JanaGreen (original poster member #29341) posted at 6:31 AM on Saturday, January 8th, 2022

Ok guys, I think this is probably an odd thing to post about, but maybe somebody can help.

My partner is a bit older than me. Two years ago, it was time for his first foray into colonoscopy land. They found polyps, a lot, and told him that he needed colonoscopies even more frequently due to that. Well, apparently once polyps are found, the colonoscopy is no longer coded as exploratory (covered by insurance) and becomes diagnostic (goes towards deductible). I may have the codes wrong, it's been a whila since we discussed that part in particular, but the important thing is that insurance coverage changes after something is found.

I harassed him all last year to get another one, but he says he simply cannot afford it (his deductible is sky high and he's not a rich guy). After a small scare with bleeding, he talked to his doctor who said the bleeding was likely hemorrhoids, but given his last colonoscopy it is absolutely critical for him to get another one.

So he basically gave me the oh well, it's too much money spiel again and I told him I will absolutely not let this go. He said he's going to call around and see what his options are at different practices, but I wanted to see if anyone here has advice. I absolutely loathe our healthcare system. This is such an absurd thing for someone to have to try to navigate!

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id 8708478
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BraveSirRobin ( Guide #69242) posted at 12:23 PM on Saturday, January 8th, 2022

Unfortunately, I don't have any advice on funding it, but I agree that it's not something he can afford not to do. Two of my H's family members had their lives saved by discoveries made during a routine colonoscopy.

I do get it. I resisted an x-ray that I needed for a foot injury because we had new insurance late in the year and the deductible wasn't pro-rated. But when the doctor told me I really had to go, I went.

WW/BW 50s (Me)
BH/WH 50s (TimeSpiral)

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zebra25 ( member #29431) posted at 3:23 PM on Saturday, January 8th, 2022

Has he checked with the hospital to see if he qualifies for any type of discount? Our hospital will write off a portion of the bill if the patient qualifies financially. It couldn't hurt to ask.

Even if he has to make payments on the bill in order to have the test done tell him to have it done!!!

I had some bleeding and was told it was probably hemorrhoids so I put off the test because I was nervous. It was not hemorrhoids. I also have had precancerous polyps removed and have to have frequent colonoscopies.

Good luck.

"Don't let anyone who hasn't been in your shoes tell you how to tie your laces."

D-day April 2010

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tushnurse ( member #21101) posted at 7:11 PM on Saturday, January 8th, 2022

So the first was a screening and is covered without deductible as it is preventative medicine.

This one will not be a screening as you pointed out. He needs to find a dr that is willing to do it at a stand alone clinic/surgery center. Which most GI Drs do because they make more $$ doing them there than a hospital. Things to ask and consider.
1. Do it without sedation. That cuts out the anesthesia costs. It used to be done without regularly and isn't really painful except for making some turns which his Dr or the nurses can coach him how to breath through. Removal of polyps is painless.
2. Work out a payment plan with the facility that does it or ask if they have self pay scale to avoid the whole insurance piece all together.
3. Do NOT allow him to not do this. He thinks a scope is expensive it doesn't come close to surgery and chemo and time away from work. 99%of colon cancers start as polyps. If they aren't removed when small then they turn into monsters.

Me: FBS
Him: FWS
Kids: 21 &23
Married for 28 years now, was 16 at the time.
D-Day Sept 26 2008
R'd in about 2 years. Old Vet now.

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 JanaGreen (original poster member #29341) posted at 1:20 PM on Monday, January 10th, 2022

Thank you guys, this is such good solid advice. It's crazy how difficult this is even WITH insurance!

I don't want to stress him out but I'm going to have to press him about it some more, I think he's kind of in ostrich mode about it.

posts: 9446   ·   registered: Aug. 17th, 2010   ·   location: Southeast US
id 8708834
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grubs ( member #77165) posted at 3:08 PM on Monday, January 10th, 2022

Just like to point out it's better to do expensive procedures at the beginning of the year as it pushes you to max out of pocket as early as possible. It may be that he can offset some of the procedure cost by saving paying for less expensive procedures later in the year.

posts: 877   ·   registered: Jan. 21st, 2021
id 8708843
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 JanaGreen (original poster member #29341) posted at 3:17 PM on Monday, January 10th, 2022

That's a great point, grubs.

posts: 9446   ·   registered: Aug. 17th, 2010   ·   location: Southeast US
id 8708845
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wildbananas ( member #10552) posted at 3:33 PM on Monday, January 10th, 2022

Thanks for bringing this up, Jana! I'm in the same boat - they found a few polyps at my first colonoscopy and told me I needed to be seen in 3 years, which is right now. It never occured to me that this might not be covered by insurance! And thanks for the tips, tush and grubs.

Travel light, live light, spread the light, be the light. ~ Yogi Bhajan

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Catwoman ( member #1330) posted at 6:11 PM on Monday, January 10th, 2022

So the first was a screening and is covered without deductible as it is preventative medicine.

Actually, that's not the way mine worked. I had a screening colonoscopy and because the results were sent to pathology, the coding changed and I owe a good $3K out of pocket. The pathology was clear, but they want me to come back after 6 months. It's crazy, and I have very good insurance.

Cat

FBS: Married 20 years, 2 daughters 27 and 24. Divorced by the grace of GOD.
D-Days: 2/23/93; 10/11/97; 3/5/03
Ex & OW Broke up 12-10
"An erection does not count as personal growth."

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