Colonoscopy ... again!
 

Time flies when you are having fun! Almost 7 years ago I posted this: http://britishexpats.com/forum/trail...e-cake-637093/ . Today I had my next scheduled event (should have been 5 years but I got lazy).


This time, it was even better - rather than drink 4 liters of the salty, sickly liquid for hours and hours, I was given a buch of tablets to take - OsmoPrep. All I had to do was take 20 tablets over a 1 hour period the day before (5-6pm), then take 12 more over a 30 minute period at 5am the day of. You get to wash them down with Apple Juice, or some other pleasant drink, and keep your taste buds happy.


Insurance rejected the prescription at first, since the liquid is OTC and dirt cheap, while the tablets are about $200, but I called the doc's office and they pushed back on the ins. co. and they agreed to cover it.


The procedure itself was the same as last time - show up, lie down, get looked after by friendly nurses, get an IV, then take some deep breaths of some magic potion, drift off into LaLa land for 45 minutes, then wake up in the recovery room with everything done. No pain.


Interestingly, they found no polyps this time (last time found 2) so I guess that means things are doing OK down there! They did mention diverticulosis again, but must not be bad enough to do anything about.


As before, I'm posting this to encourage all those over 50 to go get it done, as it is the #1 way of detecting certain cancers in men over 50 (and covered by insurance as a preventive procedure, not subject to any deductible).

Re: Colonoscopy ... again!
 

When I had my last one, maybe six years ago, I ended up with significant charges, even though it was supposedly a preventative procedure, covered 100% with no copay or deductible. First, the anaesthesiologist charged me $600 or so. Small print with the insurance policy was that the procedure was covered, not the anaesthetic - supposedly you could have the procedure without anaesthetic. Second, they found polyps & removed them. This meant the procedure was no longer preventative, but an actual procedure, so normal copay and deductible came in to play. Another $600 or so.

My HR director was appalled at this, we went back and forth for two years with the insurance company. I don't really have the stomach for this stupidity, I ended up paying both bills. End result, HR stopped promoting and encouraging colonoscopies, and I was more determined than ever NOT to grow old in America.

Re: Colonoscopy ... again!
 

For those who reject a colonoscopy because of the cost, or the idea it is painful or unnecessary, please read on.....

I'm a 79 year old Canadian currently living in Bali. I've never had a colonoscopy although, under Canada's (BC) Medical Services Plan (MSP), I've had free annual medical and prostate checks (paid US$60 for the PSA)...but at no time was a colonoscopy advised.

Over Xmas I had some stomach discomfort and my Bali doctor prescribed a colonoscopy. The procedure under a general anesthetic, one night in private hospital room and purging (2x45mL Fleet phospho-soda) and enema needed, prior to the procedure, cost around US$550.

I'd hoped the result would be so I could boast in my local pub that I was a 'perfect asshole.' Sadly, they found a large tumor at the top of my colon. Further CT scan suggested it had migrated to my liver.

A professor surgeon was introduced and, after scanning my prognosis said..."The only thing to do is surgically remove the tumor and cauterize the spot on the liver."
I said "when?" and he replied he had a surgery available in 4 days...I accepted.

Suffice to say that was 6 months ago. I was operated and the tumor and about 15 inches of colon removed. It had metastasized but my liver was clean...I suggested to my surgeon that was because I had cleaned it with alcohol for over 50 years...:thumbsup:
I've been on 6 cycles of oral chem-therapy (420 pills costing US$4 each) till last Saturday and my blood tests say I'm clean....but I'll have another CT scan tomorrow and a colonoscopy in a couple of months to confirm.

The moral of this is...if I'd had a colonoscopy, say 10 years ago, the polyps would have been removed and I wouldn't go thru' this painful and expensive treatment...so far about US$20,000. At my age no insurance company would cover me and a return to Canada (MSP) would entail a waiting period.

As others here advised...and I'd also concur, if over 50, get a colonoscopy. If no problem get another in 5 years...if defective polypses are detected they can be removed with the colonoscopy tool during the process.

Re: Colonoscopy ... again!
 

I had an American colleague in Saudi who got one done in Bangkok every year. We used to joke that he must have enjoyed it. Hey-ho, I suppose if it catches colon cancer it must be worth it.

Re: Colonoscopy ... again!
 

Nothing wrong with the procedure, just the very nature of the prep is no fun .... since prep takes about 24 hours ....

Re: Colonoscopy ... again!
 

If you are going to have doctors sticking their fingers up your bum, going to a country where they have a lot of small-handed doctors is a good idea.

Re: Colonoscopy ... again!
 

The practice where I go is 70 year old dad and 35 year old daughter in law. I always seem to get the dad.

Re: Colonoscopy ... again!
 

When I had mine done earlier this year I was given a different liquid to take. Drink about a pint 24 hours before and another pint either 5 or 6 hours before. It didn't taste that bad and I had no trouble drinking it. Better than the old stuff they used.

Don't forget the Vaseline and baby wipes to reduce soreness. :thumbsup:

Re: Colonoscopy ... again!
 

My g/f had one a few years ago and she also got hit with a charge for the anesthesia service. Based on this experience, I made sure this time that both the procedure and the anesthesia were covered ahead of time. Sad that you have to deal with all this bureaucracy, but still worth it.


They found / removed polyps during my procedure 7 years ago but it was still considered preventive. I believe this all comes down to 'coding' - how they coded the procedure. I specifically discussed the coding with the doctor prior to the procedure to ensure it would be covered. Now, I'll have to wait 6 months before I can be sure there are no charges, but I've been assured there won't be any.


I understand the sentiment that you don't want to grow old here - I have the same fears - but on the other hand, I've heard that in the UK no one ever gets a colonoscopy checkup as a preventive procedure so early detection does not occur. In fact one friend of mine in UK did have colon cancer, and said in retrospect it would have been detected much earlier had he had the procedure. My brother (5 years older than me, also in UK) won't even entertain the concept because he's never heard of it and thinks it 'odd' (he'd generally have to be at death's door before he'd see any doctor about anything, that's just his way).

The prep is no fun, but as I mentioned in my post this time, there are better products available if you ask for them, as I did (the OsmoPrep). The prep 7 years ago involved drinking 4 liters of icky salty liquid, this time I just drank apple juice - a world of difference. Yes, you need to form a close relationship with your toilet (you poop/squirt as if you ate the worst curry of your life, although with no stomach pain) but that part wasn't as bad as I expected.

Re: Colonoscopy ... again!
 

Any chance you can remember / find out the name? I'm keeping notes for the next time :). The product I used this time was 'perfect' as I got to drink apple juice and take pills, but in case I can't get it, I'd like to know what else to ask for!


I have absolutely no pain ... it's now 24 hours after the procedure and the expected soreness hasn't manifested itself!

Re: Colonoscopy ... again!
 

You need to ask for a lot of things both in the UK and US. I has a preventative sigmoidoscopy when I was back in England. The latest thing is the US that seems to vary is vitamin D deficiency testing. Some places this is covered , others it is not.

Re: Colonoscopy ... again!
 

This article discusses the whole subject of whether or not the 'screening' is still free if they discover and remove polyps. Seems like a big topic, and seems like insurance companies are falling into line.


Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit – Report – 8351 | The Henry J. Kaiser Family Foundation


ETA: Another article that discusses the polyp issue:
http://khn.org/news/health-law-colonoscopy/

Re: Colonoscopy ... again!
 

This is what one insurance company decided

The committee agreed to move forward with Medicare PDT’s recommendation to cover colonoscopies in full and offset the cost by increasing the OP surgery copay by $15.

Re: Colonoscopy ... again!
 

This may be of interest to you.

Despite not being covered by Medicare, use of computed tomographic colonography (CTC), commonly referred to as virtual
colonoscopy, is on the rise, according to the Journal of the American College of Radiology. Researchers found that in 2008, 17 percent
of hospitals offered CTC, up from 13 percent in 2005. xxxxx Healthcare, the only hospital in the region to offer the service,
started its program in May 2008 and has since conducted more than 130 procedures.

Re: Colonoscopy ... again!
 

Suprep Bowel Prep Solution. Two bottles in the kit. You add water to make up each one to 16 ounces. FAQs - Bowel Prep Kit - SUPREP

Not after I meant to use while the prep is taking effect.

Re: Colonoscopy ... again!
 

There's a problem with unnecessary treatments. Most old men die with it, but long before it has caused any issues, so over-diagnosis causes many to undergo painful treatment for something they would never have had to deal with. No one is really sure of the balance yet. Or is that prostate cancer? I seem to have filed it all into the doctor-butt-stuff part of my brain.

Re: Colonoscopy ... again!
 

My doctor said that they were getting a fair number of false positives with the PSA tests. If it came back positive you would go through all the procedure for nothing. they have upped the age requirement now.

Re: Colonoscopy ... again!
 

You're thinking of the prostate test where doctors stick a greasy finger up the anus and tickle the prostate....but never buy lunch or send flowers.
I wrote a little ditty about my experience....

The casual talk about the weather.
The wry smile and the bend-over call.
The snap of the rubber glove.
The smell of petroleum jelly.
The coolness of the insertion.
The slight wiggle.
The result….."Your prostate is the same size".
The relief.
The embarrassing tissue clean-up.
The murmured "Thank you, Doctor...Thank you, Nurse".

All reminds me... I'm due again ...

The Colonoscopy is when they send a canon telephoto camera all the way (5-6 feet) up the colon to the chest, whilst taking selfies...there's no touchy romance...and if the R2D2 camera machine finds any enemies it cuts or burns them...execution-wise.:nod: Its all business...there's no messing around in the tunnel of Guano...:rofl:

Re: Colonoscopy ... again!
 

Dire Straits?

Re: Colonoscopy ... again!
 

Very:nod:

Re: Colonoscopy ... again!
 

:thumbsup:

Re: Colonoscopy ... again!
 

Your response in script is thumbs up...

Re: Colonoscopy ... again!
 

Ha!

Re: Colonoscopy ... again!
 

Re: Colonoscopy ... again!
 

Colonoscopy screening is available in the UK, although they do FOB testing (non invasive) initially once you reach a certain age, I believe it's from 50 onwards.. If you have a positive FOB you're referred for a colonoscopy as a Urgent Suspected Cancer so from diagnosis to plan of care within 10 days or that's the target. I used to work in an Endoscopy unit and a centre of excellence for Colorectal Surgery. The screening patients had amazing care although the UK doctors I worked with rarely gave sedation let alone anaesthetic and 90% of the patients were happy with the lack of sedation they chose. It's actually pretty dangerous and easy to perf a bowel with a patient who can't express discomfort...

Re: Colonoscopy ... again!
 

Interesting. I just looked up FOB, basically it's a stool sample. I do that also once a year (part of the annual blood/urine tests I get). So you are saying, if you get a negative FOB (Fecal Occult Blood), then there's really no reason for a colonoscopy? I'm sure there are interesting studies either way.


I have heard of the punctured colon issue - a friend-of-a-friend had that happen to him during his colonoscopy. Expressing discomfort ... wow, that takes on a whole new meaning! I guess you are saying it's not that painful. I'm thinking I'll probably never find out as I'm a wimp, but something to consider I guess!

Re: Colonoscopy ... again!
 

The Australian government sends out free FOB screening tests to everyone as a 50th birthday gift.

Re: Colonoscopy ... again!
 

I read a paper on the statistics of colonoscopy, and, IIRC, unless you have familial or previous history, then the prophylactic colonoscopy is riskier than waiting for a positive FOB, provided you ARE doing FOB

Re: Colonoscopy ... again!
 

Do you know anything about computed tomographic colonography (CTC), commonly referred to as virtual colonoscopy, from post #14

Re: Colonoscopy ... again!
 

We have just cancelled our colonoscopy appointments for Friday. We, the wife and I, had our annual physicals recently and the Doc advised that we have colonoscopies. These would be free of charge, courtesy of our health insurance, as preventative measures. Never had one before having had the FOB type each year. We had to go for a consultation first which consisted of a 10 minute chat with the Doctor followed by BP and pulse/temp etc. Then given instruction pamphlet of what to do the day before All of which could have been done by a first year med student. On checkout we were asked for $340 each as a consultation fee!!!! Never paid and contacted the insurance company who said that they would pay.
My wifes' Doc gave her a prescription for the preparation, whilst I got details of over the counter preps. The prescription would have cost $120. Left it there and got the over the counter preps for us both for less than $30.
Since reading this post and learning that the Colonoscopy group are linked to our Doctors group we decided to cancel and return to the non-invasive test. We are both low risk for Colon Cancer and believe it is sufficient for us to continue with the FOB.

Re: Colonoscopy ... again!
 

Agreed, the prep, fasting and violent movements are by far the worst bit. I have no fear of anesthesia, but I know others who are morbidly afraid of going under and never waking up. If I have to go, that wouldn't be such a bad way....

Re: Colonoscopy ... again!
 

I'm just finishing up a project for the Western Australia department of health auditing colonoscopy waiting lusts. From what the gastro doctors have said, you're more likely to develop cancer from the high dose radiation of the CT than from colon cancer. The advice they give is that if you are otherwise low risk for developing bowel cancer and have no symptoms then the non invasive FOBT is the best way to go.

Re: Colonoscopy ... again!
 

I have had lots of colonoscopies and I know it was necessary but I've never had a lust for them:ohmy:



:lol:

Re: Colonoscopy ... again!
 

We all have our predilections SM. :lol:

Re: Colonoscopy ... again!
 

:thumbsup:

I must admit, I would be more than happy if there was a better prep to the procedure. Between June last year and April this year I had 3 colonoscopies and 1 endoscopy. I certainly have no lust for them, and next March I am scheduled for another one.:thumbdown:

Re: Colonoscopy ... again!
 

I will return and post further but we're moving house tomorrow and I've not had much time. One minute you think you're sorted, the next there seem to be cupboards full left to pack:sneaky:

Re: Colonoscopy ... again!
 

My father was, and refused a heart valve replacement, thereby condemning himself to entirely predictable death. His condition had a prognosis of death 3-5 years after diagnosis. He died four years, to the month, after diagnosis. :( [ETA I only researched the prognosis after the post mortem had confirmed the diagnosis. He died three months before Mrs P was confirmed to be carrying his only grandchild.]
I agree, so long as it was unexpected. The thought of euthanasia scares me, though I could imagine circumstances when it becomes appealing.

Re: Colonoscopy ... again!
 

Besides the old familiar FOB test, I understand that there's a new one called FIT that is supposed to be more sensitive. There is also a test called Cologuard which is apparently pretty good, but costs about $600. I looked into virtual colonoscopy, but even the folks at the radiology center didn't recommend it as if anything is found you're back to square one, needing a colonoscopy to get the polyps snipped. In the US, Medicare covers the colonoscopy (unless, as others have said, something is found and a preventative is transformed into a procedure), and it covers the Cologuard test. It does not cover the virtual colonoscopy.

Re: Colonoscopy ... again!
 

Your decision to stick with the FOB is yours to make based on your understanding of the risks/etc, and it may be the perfect decision for you. But the financial side of the above experience, I don't understand at all. I had the same consultation, as well as the procedure, 100% covered, and also got the more expensive OsmoPrep covered by the insurance company simply by calling the doctor and asking him to justify it to the insurance co (when I first picked up the prescription, the pharmacy said it was not covered and I would have to pay $200 or so; but I called the doctor's office, and we agreed that the cheaper liquid made me nauseous and thus, the more expensive option was required ... so they contacted the insurance co and they reversed their decision).


I am impressed by the level of info in this thread, though - interesting to read about the virtual option, and the relative risks. I'm personally somewhat concerned about the puncturing aspect ... that would be my biggest reason to avoid it. As for the anesthesia - 'going under' is a beautiful feeling and I only wish they could make it last longer (the transition)!

Re: Colonoscopy ... again!
 

I want to update this thread with my struggles with insurance over my last colonoscopy.

Despite being very clear with the Doctor's office that this was to be a preventive procedure, and coded/billed as such, I got FOUR bills for the procedure.
1) pre-procedure consultation
$372 reduced by an insurance adjustment of $168, for a final charge of $204.

2) procedure, doctor's charge
$675, reduced by an insurance payment of $411, for a final charge of $264.

3) procedure, surgery center charge
$3,800 reduced by 'insurance write-off' of $1,547, and an insurance payment of $757 for a final charge of $1,497.

4) post-procedure consultation
$252 reduced by an 'insurance adjustment' of $153 for a final charge of $99.

I simply refused to pay these charges, and kept calling the doctor's office saying this should all have been covered, and that they needed to correct their 'coding'. I also called the insurance company several times, with a similar message. It seemed to go round in circles, with the same bills arriving every month or so.

Finally, I called the insurance company again, and got some very helpful young lady in the Philippines who seemed to have some discretion and she said she would get it all taken care of, and finally I got a confirmation that everything was covered. She indicated that the root cause of the problem was that the doctor's office kept using the wrong codes.

So ... the moral of the story is, don't pay and keep fighting until they cover it!