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Getting around insurance cap on colonoscopies

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Posted 2/8/2013 8:57 PM (GMT 0)
Has anyone gotten around the insurance cap of $1500 on colonoscopies by having a UC diagnosis and it being "non-routine"
Posted 2/9/2013 3:12 AM (GMT 0)
No, I haven't but I hope someone here can help you find some answers. I notice insurance has so many rules that it's difficult to get the services you need without spending an arm and a leg. It makes me wonder why I bother participating in a plan.
Posted 2/9/2013 3:41 AM (GMT 0)
Hi Journey2Health - I can't answer this question but maybe you can answer mine.

You posted this in a thread about adrenal insufficiency and I'm dealing with the same problems:

journey2health said...
"Hi Baggravation, I was on prednisone a total of 14 months, and I tapered so slowly t to one milligram every other day. I tested at 5 mg. and my cortisol function was not there, and the GI said I'd have to be on pred the rest of my life and he wanted me to be on 7.5 for the rest of my life, which is the equivalent of what your body produces. He scared me into believing I would go into adrenal shock if I got off pred. I said I wanted another opinion so I went to an endocrinologist who saw me the soonest possible time (5 months later). Meanwhile I kept tapering and, against my doctors wishes, wouldn't go back up to 7.5 daily, even though my GI was arguing against it and that I should realize my own cortisol function wasn't coming back. By the time I saw the endocrinologist, he said, I had made a decision to take a risk and "side with nature" My body returned to normal. It just took a long, long, long time. And I never got a second cortisol function test.

I don't know what else to tell you. That's my story with pred and cortisol function."

My question exactly how long it took you to get adrenal function back. Did it come back when you were off prednisone or during the wean?

Thanks in advance.
Posted 2/9/2013 6:05 AM (GMT 0)
Hi, Stealth

The point is I never knew if it came back because I never tested a second time.

Not once did I feel bad physically.

I was just told I could feel fine then have a major crisis like a car accident and go into adrenal shock.

I hated pred so much that I didn't care. I just wanted to get off pred.

The endocrinologist said five months after the test that I was probably fine. I just decided not to get tested again.

So maybe you should see an endocrinologist. I know I didn't want my GI telling me what to do about something an endocrinologist handles.

Are you feeling any symptoms of adrenal insufficiency.

I had none.
Posted 2/9/2013 6:05 AM (GMT 0)
So, NSSG, are you saying that your plan has a cap on colonscopy service.s Mine caps at $1500.
Posted 2/9/2013 9:46 AM (GMT 0)
I am enrolling in a clinical trial, free colonoscopy.
Posted 2/9/2013 4:03 PM (GMT 0)
http://www.kff.org/healthreform/upload/8351.pdf

This is a report on colonscopies under the Affordable Care Act. I've only had time to read a paragraph of it. But it's major point is that the caps on colonscopy coverage are dissuading people from getting them and they are the best screening for one of the most common types of cancer -- colorectal.

Anyway, will get to it later in its entirety. Maybe it will have an effect on those caps.

Enjoy the read.
Posted 2/9/2013 5:07 PM (GMT 0)
My plan wouldn't even pay for the colonoscopy because it's required for a "condition". It would only cover it if it were preventative and unrelated to an existing condition. I would only get it paid for if I had met my deductible, which is $1000, and even if I had met that, I'd have to pay 10% out of pocket (+the inpatient fees whatever they are) up to the plan max out of pocket which is $3000. After you spend $3000, everything is covered *I think*. I wouldn't be surprised if it's not and I was misreading the literature. I think I am going to switch to an HMO that has better coverage.
Posted 2/9/2013 7:46 PM (GMT 0)
It's required for a condition, but with the unlucky UCers it's not a matter of if but when we get cancer. So it is a screening for a people with a much higher risk of cancer.



Going to fight this one!
Posted 2/9/2013 8:59 PM (GMT 0)
My plan doesn't care about the secondary preventative reasoning. I had blood work for UC but it was also preventative to check my liver for damage from 6mp and I was not able to get my insurance to pay for it.
Posted 2/9/2013 11:14 PM (GMT 0)
Marry a Canadian for their healthcare bennies? Or a Frenchman? Turn 65 and get Medicare?
Sorry for the smart-aleck reply, I don't have a clue otherwise.

I had a colonoscopy recently and have high deductible insurance so didn't notice a cap since they didn't pay anything anyway. However they did negotiate a couple thousand dollar anesthetist bill down to $200+.
So I guess that's what I pay them $550/month for, hmmm?

I'm 58 so I guess I'll have at least one more self-paid c-scope before Medicare kicks in.
Posted 2/10/2013 12:08 AM (GMT 0)
As a 54 year old, that's a good way of looking at it, Imagardener,
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