Screening for colon cancer (or colorectal cancer, bowel cancer)

[sengsational]

The only person living with the consequences is the patient.

The doctors don't even have to live with the statistics they generate, which seems absurd to me. I like the commercial airline model: the pilots are always the first ones on to the site of the crash. And wouldn't you know it, one of the safest industries!

 

[Sojourner]

Colon cancer is one of the cancers that is almost 100% preventable--the way to prevent it is to have a colonoscopy. I don't understand why anyone would not do that. I just wish that some other cancers--like pancreatic cancer-- were preventable like colon cancer is.

+1

I couldn't agree more with this. I just had my first routine colonoscopy earlier this month, and two small polyps were removed. They would still be inside my body, waiting to become cancerous at some point, had I opted to do a DNA screening test (like Cologuard) or a hemoccult test. Why in the world would anyone take a chance with leaving precancerous polyps in-place inside their body? As uncomfortable and unpleasant as the one-day colonoscopy prep was, I'll be repeating it every 5 years as long as my doctor feels it's warranted. The only way I wouldn't do that is if the risks of colonoscopy outweighed the risks of developing fatal cancer... which they don't, not even close.

 

[OverThinkMuch]

I heard so many folks complain about getting a colonoscopy…the prep, the fasting, the this, the that. I’ve had two now. Clean on both. They are not that big of a deal.

For some who play on their phones or read in the bathroom - think of this being an all day bathroom excursion. But actually, I found you can wander elsewhere and still have a minute of warning before you need to return to the throne room.

 

[athena53]

+1

I couldn't agree more with this. I just had my first routine colonoscopy earlier this month, and two small polyps were removed. They would still be inside my body, waiting to become cancerous at some point, had I opted to do a DNA screening test (like Cologuard) or a hemoccult test. Why in the world would anyone take a chance with leaving precancerous polyps in-place inside their body?

It was actually the hemoccult test that gave me the incentive to do the colonoscopy. My gyno suggested it and when that came back positive I knew it wasn't conclusive but that it was an indication that I needed a colonoscopy. That first one turned up a pre-cancerous adenoma. I've been on 5-year recall ever since. So... if those tests convince someone to get the Real Thing, it's a start. And I did thank my gyno later.

 

[Bamaman]

Like yearly physicals, including chest x-rays, colonoscopies after the age of 50 every 5 years is most important. Nothing worse than having a doctor tell you you're stage III or IV when you didn't know there was a problem.

The finest general surgeon in my home town has probably done a thousand colon cancer surgeries. But he had never received a colonoscopy at age 74, and he died promptly. Yes, cancer is equal opportunity, and everyone needs to be ahead of the curve.

 

[Teacher Terry]

I haven’t had a colonoscopy in 14 years so decided it was time. The prep wasn’t as nasty as before but my body still doesn’t like it. I am waiting for my friend to pick me up. I have a massive headache but considering my siblings make a ton of polyps I decided it was prudent.

 

[tulak]

Hope it goes smoothly!

I had my first colonoscopy last week. I didn’t mind the prep. I was happy that I had an afternoon appointment. I didn’t have to wake up early for the 2nd round of prep and had plenty of time to get to the appointment.

Luckily nothing found and I’m good for five years.

 

[Teacher Terry]

All went well. Good thing I had it done as I had 5 polyps. They were sent to biopsy but the doctor said look benign. I was hoping that could be my last one but now I will have one more before 75.

 

[harllee]

All went well. Good thing I had it done as I had 5 polyps. They were sent to biopsy but the doctor said look benign. I was hoping that could be my last one but now I will have one more before 75.

So glad you had your colonoscopy. The procedure is no fun but it saves so many lives.

 

[Dtail]

So glad you had your colonoscopy. The procedure is no fun but it saves so many lives.

True. Now the opposite sex needs more convincing to have one.

 

[Amethyst]

Husband saw the doctor for what he thought was constipation, which diet, etc. wasn't helping. She prescribed Cologuard.

"Abnormal DNA" was found, and a colonoscopy showed two very large (Dr. said they must have been growing for 35 years!) precancerous growths which were starting to obstruct the bowel.

Removal (at a real hospital, instead of the colonoscopy farm) provided instant relief of all symptoms.

One bad thing was that our insurance didn't cover the lab that "read" the Cologuard test. It was the first time we'd ever had anything go out of network. $700 out of pocket for that.

It was actually the hemoccult test that gave me the incentive to do the colonoscopy. My gyno suggested it and when that came back positive I knew it wasn't conclusive but that it was an indication that I needed a colonoscopy. That first one turned up a pre-cancerous adenoma. I've been on 5-year recall ever since. So... if those tests convince someone to get the Real Thing, it's a start. And I did thank my gyno later.

 

[Teacher Terry]

Amethyst, this is a situation where the price you paid was definitely worth it).

 

[harllee]

Crazy to me that the insurance companies will not pay for colonoscopies that find a polyp. Removing a polyp early saves thousands of dollars (plus lives) later on. Penny wise and pound foolish.

 

[Teacher Terry]

They won’t pay for colonoscopies once you have a positive test for cologuard.

 

[RetMD21]

They won’t pay for colonoscopies once you have a positive test for cologuard.

That doesn't make sense. Are you sure?

 

[Out-to-Lunch]

That doesn't make sense. Are you sure?

I personally agree with you that this policy seems misguided. However, it seems to be the case:

https://www.loyolamedicine.org/assets/documents/forms/digestive-health/colonoscopy-faqs.pdf

If you have any abnormal stool tests such as FOBT, FIT or Cologuard, then your colonoscopy is considered a “diagnostic” colonoscopy.

It is even worse than just Cologuard. From that same document, even a family history of colon problems will make a colonoscopy into a "diagnostic" one, which, depending on your insurance plan, may be charged out of pocket. Aren't people with a family history (but no current symptoms) exactly the people that you would WANT (from a public health perspective) to test?

 

[Montecfo]

They won’t pay for colonoscopies once you have a positive test for cologuard.

Correct. They pay for screening colonoscopies only.

Another good reason to get one.

 

[Aerides]

Do you mean that they won't pay as a completely covered event, or that you can't even get it submitted to insurance, subject to deductibles and what not?

I know a preventative screening one is no charge, but once you have polyps then it's seen as diagnostic and therefore much like any other medical procedure - but still...covered. Just not zero out of pocket.

 

[Montecfo]

Do you mean that they won't pay as a completely covered event, or that you can't even get it submitted to insurance, subject to deductibles and what not?

I know a preventative screening one is no charge, but once you have polyps then it's seen as diagnostic and therefore much like any other medical procedure - but still...covered. Just not zero out of pocket.

Correct. It becomes regular medical care subject to whatever your policy states.

 

[RetMD21]

So if you mean they won't cover it as a screening colonoscopy that makes sense. These are often "free." They will cover a diagnostic colonoscopy subject to whatever copays and deductibles you have.

 

[Teacher Terry]

Ret md, yes that’s what I meant.

 

[RetMD21]

the Loyola link is wrong about the coding. Here is a better link. https://gastro.org/practice-guidanc...ht code to,decompression [separate procedure]).


Also there are plenty of screening codes for previous polyps, cancer, and family history to justify more than every 10 year billing. https://www.surgicalnotes.com/news/2021/june/2021-asc-coding-tips-screening-vs-diagnostic-col/

 

[Out-to-Lunch]

the Loyola link is wrong about the coding. Here is a better link. https://gastro.org/practice-guidanc...ht code to,decompression [separate procedure]).


Also there are plenty of screening codes for previous polyps, cancer, and family history to justify more than every 10 year billing. https://www.surgicalnotes.com/news/2021/june/2021-asc-coding-tips-screening-vs-diagnostic-col/

Thank you very much for those resources.

 

[sengsational]

I don't think screening colonoscopies have been treated the same over the years.

There was a time when a screening colonoscopy was later flipped to a diagnostic colonoscopy if a polyp was discovered, but I think they changed that rule so that if you go in as a screening, it stays a screening, no matter what they find.

Once you have any "history" of colon trouble, everything from there out is going to be diagnostic, even if you don't have symptoms and you're just coming back in 5 years, or whatever.

 

[PaunchyPirate]

My insurance experience with 2 colonoscopies…

My first colonoscopy was done around age 54 while I had good UnitedHealthcare insurance via my employer. That colonoscopy was 100% paid for by my insurance. That Doctor did not require a pre-procedure office visit. Three polyps were found and removed and I was told to get my next colonoscopy in 5 years.

My second colonoscopy was done after I retired and while I was on an ACA insurance plan from UPMC Health Plan (a major insurance company here in Western PA). I also had relocated, so I used a new local doctor for the procedure. This doctor required a pre-op office appointment with his Physician Assistant. I told her my previous polyp history. She advised me that this made my upcoming procedure Diagnostic and I would likely have to pay for a portion of it since insurance would not cover it all. The day of the procedure, before I went under anesthesia, the Doctor and his assistants were discussing my previous polyp history. I had one polyp removed and was told to get my next one in 7 years. I’ll probably do it in 5 just to be proactive.

When all was done, my insurance paid for 100% of the procedure and all I paid was my normal co-pay for the doctor office visit.

I don’t know why insurance paid for it all, but I was happy.