So Frustrated....

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tminor5
Posts: 40
Joined: Wed Jun 13, 2018 11:46 am

So Frustrated....

Postby tminor5 » Thu Aug 16, 2018 5:22 pm

So with everything my husband has been going through I have decided to get all my scans and stuff done that hasn't been done in a long time. Colon Cancer runs in my family. My mom's dad had it at 50 and they have found polyps in my mom. So I get the recommendation from the doctor to get a colonoscopy done. Had it all scheduled and they called today to tell me what our insurance said. I don't even know if my husband's work realizes they did this (they do now) They have it set as preventative/routine colonoscopy FROM 50. That means that even with a family history you can't get one until your 50. I would have to pay out of pocket, oh and it doesn't go to deductible, out-of-pocket or anything. With all my husband's crap and stuff we can't afford that. If I was 50 it would be covered 100%. Needless to say he's letting his HR know that the way they did the policy made it that even with a family history you can't get a colonoscopy until your 50. I still have 5 1/2 years till then. I do have to say the doctor office was baffled as to why they would've set it up that way. But then again this is the same place that everyone things they have short-term disability until they need it then realize its work related only. Sorry for the vent, I had to say how frustrated I was somewhere.
DH DX at 46  pT4a,pN1a CEA 1.6
5/25/18 ER bowel obstruction
5/26/18 Colonoscopy couldn't insert stint
5/27/18 Surgery removed 18", not seen on any near by organs, colostomy due to infection
6/25/18 1st FOLFOX (12 cycles)
11/26/18 Last chemo
12/17/18 Colonoscopy clear
3/29/19 Colostomy takedown (temp illeo because of scaring)
5/23/19 Scan (sm node lung believe scar tissue)
6/20-7/25-8/9-8/20-9/5-9/26 Colon stretch for illeo takedown
10/3/19 Scan (node same)
10/25/19 Ileo takedown

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juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: So Frustrated....

Postby juliej » Thu Aug 16, 2018 6:29 pm

The American Cancer Society announced new guidelines for colonoscopies this summer. Now the official start of screening age is 45, instead of 50. Generally speaking, insurance companies change their coverage to match the ACS guidelines.

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

I would write to the insurance company and attach a copy of the new guidelines and challenge their decision. The ACS guidelines say that people at increased risk (which would include you) "might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests."

I would also get my doctor involved in challenging the decision. He/She could write a letter stating the new guidelines and affirming that you have a family history and need the test done before the age of 50.

Someone else with insurance experience might chime in with more advice, but thought I'd start the ball rolling.
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1


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