Insurance question: Are colonoscopies considered preventative?

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Ehut
Posts: 220
Joined: Wed Sep 26, 2012 4:24 pm
Location: Algonquin, IL

Insurance question: Are colonoscopies considered preventative?

Postby Ehut » Thu Oct 31, 2019 10:20 am

It's open enrollment at my company this week for my health insurance coverage next year. My boss's boss said that colonoscopies are considered preventative and should be completely covered by our insurance plan with $0 out of pocket (apparently his have been). My question is whether this applies to someone like myself who have gone through CRC and have surveillance colonoscopies frequently (every 3-4 years), particularly since I'm still under age 45. Should my insurance cover it as preventative or will I have to pay towards my deductible?
Dx 12/11 rectal stage IV w/ 6 mets to liver, age 35
4 cycles FOLFOX 12/11 to 2/12
short course radiation 2/12
rectal/liver resection 3/12, temp ileostomy
8 cycles FOLFOX/FOLFIRI 4/12 to 8/12
ileostomy reversal 10/12
port out 10/13
NED for 7+ years and counting!

KimT
Posts: 684
Joined: Sat Feb 20, 2010 8:53 pm

Re: Insurance question: Are colonoscopies considered preventative?

Postby KimT » Thu Oct 31, 2019 11:35 am

I have to pay towards my deductible for mine. Most insurance don’t consider preventive once you have been diagnosed with cancer. It’s considered follow up.
2/10 dx colon cancer
right hemicolectomy 3/19/10
Stage 2a 0/43 nodes
Lynch syndrome
3/14/10 colon resection/ removal of metal clips
Nov 11 dx ovarian cancer

NHMike
Posts: 2398
Joined: Fri Jul 21, 2017 3:43 am

Re: Insurance question: Are colonoscopies considered preventative?

Postby NHMike » Thu Oct 31, 2019 12:28 pm

I have had to pay a deductible. Also, being put under costs quite a bit more (I guess that's considered elective). In practice, it hasn't been an issue as I hit my max out-of-pocket pretty quickly.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

Ehut
Posts: 220
Joined: Wed Sep 26, 2012 4:24 pm
Location: Algonquin, IL

Re: Insurance question: Are colonoscopies considered preventative?

Postby Ehut » Thu Oct 31, 2019 2:59 pm

Thanks for the responses. From my net searches it appears that there are two categories of colonoscopy: screening/preventive and diagnostic/medical. I asked my insurance company and am waiting for their response, but I believe we are subject to the diagnostic/medial category.
Dx 12/11 rectal stage IV w/ 6 mets to liver, age 35
4 cycles FOLFOX 12/11 to 2/12
short course radiation 2/12
rectal/liver resection 3/12, temp ileostomy
8 cycles FOLFOX/FOLFIRI 4/12 to 8/12
ileostomy reversal 10/12
port out 10/13
NED for 7+ years and counting!

zephyr
Posts: 276
Joined: Thu Aug 18, 2016 7:31 am

Re: Insurance question: Are colonoscopies considered preventative?

Postby zephyr » Thu Oct 31, 2019 4:32 pm

Ehut wrote:Thanks for the responses. From my net searches it appears that there are two categories of colonoscopy: screening/preventive and diagnostic/medical. I asked my insurance company and am waiting for their response, but I believe we are subject to the diagnostic/medial category.


I would think your gastroenterologist could argue that it's preventative since you are more than 5 years NED. BTW - congratulations on that! It's experiences such as yours that give the rest of us Stage IV patients hope.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr/Jul-2019 Xeloda/Avastin, SBRT
Sept-2019 Continue Xeloda/Avastin


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