Are followup colonoscopies counted as preventative?

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Tdubz
Posts: 115
Joined: Sun May 07, 2017 11:01 am

Are followup colonoscopies counted as preventative?

Postby Tdubz » Sun Mar 11, 2018 10:57 am

Hey guys,

I have my first post chemo colonoscopy this week and I was curious if it counts as preventative care. I had to pay for a portion of the colonoscopy that diagnosed my cancer and now I’m wondering if I should have had to pay anything at all for that one. Preventative care is supposed to be free on insurance and from a few quick searches on the internet, it looks like that includes colonoscopies. I’ll call my insurance when they open but I was just curious what yalls experiences are. I’ve read it can come down to what the doctor bills it as so maybe it wouldn’t hurt to check with him too.

zephyr
Posts: 95
Joined: Thu Aug 18, 2016 7:31 am

Re: Are followup colonoscopies counted as preventative?

Postby zephyr » Sun Mar 11, 2018 11:54 am

My experience was that it was not considered preventative. The explanation I was given was that if you have no reason to believe anything is wrong, it's considered preventative -- but otherwise no. Again, this was just my experience -- your insurance company may treat it differently.

Edited to add: I'm not done with chemo. My follow-up colonoscopy that was not considered preventative was the first one after the removal of a cancerous polyp (with clear margins) several years ago.
Oct-2009 Stage I CC
Jun-2016 Stage 3 (T3 N1c)
Jun-2016 Surgery
Jul-2016 PET: Probable Stage 4 with inoperable lung mets
Aug-2016 Folfox
Jan-2017 Dropped oxaliplatin, continuing with 5FU, added Avastin
Aug-2017 Dropped Avastin, continuing with 5FU
Dec-2017 Chemo stopped working, lung mets growing but CEA stable, considering other treatment options
Jan-2018 Begin Folfiri & Cyramza (ramucirumab); also receiving Vitamin C & Quercetin by IV every week
Jun-2018 Taking a chemo break

Lee
Posts: 5557
Joined: Sun Apr 16, 2006 4:09 pm

Re: Are followup colonoscopies counted as preventative?

Postby Lee » Sun Mar 11, 2018 2:39 pm

This was years ago when "Obamacare" was still kinda new. I was told some procedures were considered preventive as long as there was not a preexist condition. In other words mammograms are preventative as long as you have not been diagnosed with breast cancer. Yes I always pay a portion of my scopes and I get my mammograms for free.

I am not with Obamacare, butt rather have insurance through my husband's company.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

benben
Posts: 255
Joined: Fri Apr 28, 2017 3:18 pm
Location: Washington State

Re: Are followup colonoscopies counted as preventative?

Postby benben » Sun Mar 11, 2018 4:09 pm

Tdubz wrote:Hey guys,

I have my first post chemo colonoscopy this week and I was curious if it counts as preventative care. I had to pay for a portion of the colonoscopy that diagnosed my cancer and now I’m wondering if I should have had to pay anything at all for that one. Preventative care is supposed to be free on insurance and from a few quick searches on the internet, it looks like that includes colonoscopies. I’ll call my insurance when they open but I was just curious what yalls experiences are. I’ve read it can come down to what the doctor bills it as so maybe it wouldn’t hurt to check with him too.


Hey Tdubz - how goes it?

I know I was following closely behind you in chemo sessions and I've got my first post-treatment scope Tuesday. So gonna eat up some good foods today, as tomorrow its all liquid. Not to mention 6pm is the beginning of the "toilet" march with the "GoLytely" (haha, yeah quite the opposite of lightly.)

Anyhow as far as the colonoscopy being preventative, I can tell you this - I had what's called my surgery pre-admission meeting last week to go over everything. First thing out of the gate I was sent to a booth where they showed me my anticipated out of pocket cost for the colonoscopy. I'll be paying $2900 out of pocket, and they made sure to let me know that's just for the procedure. There will be an additional bill for the GI Doc doing the scope. This single procedure pretty much covers my entire out of pocket expense for the year though. So if I end up needing any more treatment (praying to God I don't) - it'll be covered. Right after they showed me this bill I was sent to another room to get my vitals such as blood pressure. Then they wondered why it was on the border of being high. I was like, "Well if you want a better reading, maybe you should show your patients the bill after you take blood pressure readings." LOL.

I wish squeaky clean scopes for the both of us :)
Cheers.
----------------------
3/29/17 diagnosed CRC - 44 y/o Male
4/17/17 ULAR - Straight anastomosis - no ostomy.
Path: low grade T3n1m0 - moderate diff.
KRAS - NO, MLH1/PMS2/MSH6/MSH2 - Normal.
5/3 med port install
5/22 folfox - first treatment.
3rd treat, delayed - low ANC - reduced to 90% OXI
Granix given, Now Zarxio treatments every session.
Treatment 7 reduced to 75% OXI
Treatment 8-12 - NO OXI, just Luke and 5FU
Current - 12 treatments done, CBC good, CEA decreasing.
10/20/17 CT-SCAN - CLEAR! - NED

Ron50
Posts: 654
Joined: Fri Feb 10, 2006 7:04 pm

Re: Are followup colonoscopies counted as preventative?

Postby Ron50 » Mon Mar 12, 2018 7:21 am

I am in Australia so none of the same rules apply. But if you are asking if they are preventative only the health system would be under the illusion that they aren't. Colonoscopies are rarely for looking for recurrence. That is why we have scans. Polyps are the main target. I have had around a dozen scopes. The only one that found cancer was the first. During at least half of my scopes polyps were found and removed , not cancer , potential cancer. My last scope was in april last year , my twentieth year of survival ex stage 3c. They found four tubular adenomas , the biggest 11 mm. There is no doubt in my mind that scopes are preventative. By the way that scope did not cost me anything as I was 67 and on the age pension. Hope you have good results , Ron.
dx 1/98
st 3 c 6 nodes
48 sessions 5Fu/levamisole
no recurrence cea <.5
numerous l/t side effects of chemo

Deb m
Posts: 390
Joined: Tue Jan 14, 2014 10:08 am

Re: Are followup colonoscopies counted as preventative?

Postby Deb m » Mon Mar 12, 2018 8:09 am

I think after five years of being clear, it's considered preventive. My husbands three year follow up ,we still had to pay. Have one coming up this summer, which will be over 6 years NED. Not sure what to expect. I did call and ask my insurance company and they said it all depends on how the doctor bills it.


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