Colonoscopy: Jumping Through Hoops?

[MIGrandma]

I saw my doctor in January for my diabetic checkup. A couple weeks later he called me, said he saw my last colonoscopy was in 2013 and asked if I would be okay to have another one set up. I told him that would be fine so he sent me a written order (through my patient portal) for it and said someone from the surgeon’s office would call within 10 days to get the consultation scheduled. That happened and I went to the surgeon’s office earlier this afternoon for the consultation. It went fine, then I was sent to the scheduling department. As I am on Eliquis (pulmonary embolism) she said she couldn’t schedule the colonoscopy until she found out from my doctor how many days I needed to be off the Eliquis. She sent the form to my doctor’s office and said after she heard back from my doctor she would call me to get it scheduled.

I had just gotten home when my doctor’s office called. They wanted me to make an appointment to see my doctor about my colonoscopy. I was confused about that, and said he was the doctor that recommended I have it so why do I need to see him just to find out how many days before the procedure do I need to stop the Eliquis? She said it was “for insurance purposes.” She wanted me to come in Monday morning at 7:45 to see the doctor. I told her I wouldn’t be scheduled for the colonoscopy until June, then she said to come in June 9th. I told her I would call her back.

Does this make any sense? I don’t get why I need to see my primary doctor again when he was the one who recommended the colonoscopy and now everything is all set, except just to know how many days I need to be off Eliquis before the procedure. Is this just a “money grab” from my doctor’s office?

Im thinking about calling my insurance company (Medicare Advantage plan through Blue Care Network) in the morning to talk to someone about this, but wondered what you guys think.

 

[MICKIMINI]

That is just silly. The doctor should have a nurse call you with the number of days. Don't bother calling your insurance. Just be firm that your time is valuable too if they give you a hard time. No need for an office visit!

 

[fla4fun]

I saw my doctor in January for my diabetic checkup. A couple weeks later he called me, said he saw my last colonoscopy was in 2013 and asked if I would be okay to have another one set up. I told him that would be fine so he sent me a written order (through my patient portal) for it and said someone from the surgeon’s office would call within 10 days to get the consultation scheduled. That happened and I went to the surgeon’s office earlier this afternoon for the consultation. It went fine, then I was sent to the scheduling department. As I am on Eliquis (pulmonary embolism) she said she couldn’t schedule the colonoscopy until she found out from my doctor how many days I needed to be off the Eliquis. She sent the form to my doctor’s office and said after she heard back from my doctor she would call me to get it scheduled.

I had just gotten home when my doctor’s office called. They wanted me to make an appointment to see my doctor about my colonoscopy. I was confused about that, and said he was the doctor that recommended I have it so why do I need to see him just to find out how many days before the procedure do I need to stop the Eliquis? She said it was “for insurance purposes.” She wanted me to come in Monday morning at 7:45 to see the doctor. I told her I wouldn’t be scheduled for the colonoscopy until June, then she said to come in June 9th. I told her I would call her back.

Does this make any sense? I don’t get why I need to see my primary doctor again when he was the one who recommended the colonoscopy and now everything is all set, except just to know how many days I need to be off Eliquis before the procedure. Is this just a “money grab” from my doctor’s office?

Im thinking about calling my insurance company (Medicare Advantage plan through Blue Care Network) in the morning to talk to someone about this, but wondered what you guys think.

It could be a cash grab and it could not be. If your doctor is concerned about you going off your current medication abruptly, they may need to see you early to discuss a gradual reduction, additional monitoring, or alternate medication. There is a fine line between having enough medication in your system to treat your current condition and not so much that the removal of a polyp or two (if any are found) would be dangerous. There is really no way to know until you see them.

I don’t see a problem with calling your insurance to verify that this visit will be covered, especially if you do end up needing another visit prior to the colonoscopy. I like to make sure all my ducks are in a row when it comes to insurance since it can be difficult to resolve issues after you have already been to the appointment.

It is frustrating that doctor’s offices won’t answer questions over the phone, especially when they are the ones sending you for the test in the first place, but that’s how it is in most offices today. The only way to find out what you need to know is to see them in person. Best wishes for a successful and clear test!

 

[bluezy]

One year (about 10 years ago) I had a colonoscopy scheduled and I don't remember what happened, but I needed to reschedule it and it was going to be about 6 weeks after the originally scheduled date (which was still about 3-4 weeks away when I had to reschedule it). I had to go back to the doctor before that rescheduled colonoscopy. I questioned it and the person at the office said it was required by insurance. When I got to that appointment (which was about 2 weeks before the colonoscopy), without me even saying anything, the doctor apologized for making me come back in and said that the insurance company required people to see the doctor within 6 weeks (I think that was the time frame) of the procedure and since my original appointment was more like 12 weeks before this rescheduled procedure, she had to see me. She did a quick listen to my heart, asked me if anything had changed, and said she'd see me in a few weeks.

My sister had the same experience (rescheduling and having to go back for another office visit) and she has different insurance than I do.

Ironically, three years later, I switched to a different doctor closer to my home (same hospital network) for the next colonoscopy. I never even had to go into the office for an appointment. Never met the doctor until the day of the colonoscopy. Had another one a few months ago, again, no doctor appointment. And I still have the same insurance that I had 10 years ago.

 

[Cloudy]

Depending on what you are on the Eliquis for and your risk factors for another clot, you may need alternative medication during the time you are holding the Eliquis and it may be an injectable medication that requires education. That is probably why your doctor is making you come in for a consultation.

 

[LuvOrlando]

Can you write a note to your Dr in some kind of chart app to ask directly if it is really necessary and cut through the front desk? Sometimes when things aren't clear, like with your medicine and all plus mentioning a serious medical condition, the admins just run you through because they do not understand or say things wrong when they ask the question. I find most things get sorted with a note the Dr answers themselves. If you really must see the Dr maybe a virtual is less annoying.

 

[RangerPooh]

I just had my second colonoscopy in 4 months, I did not have to do an appt with my primary after the initial visit. However insurance companies policies vary.

There is medication that they request you stop in advance. One of my medications had to be stopped a week in advance, others the day before. My gastro office provided this info.

 

[MillauFr]

Odd our health plan has never recommended colonoscopies and we are in our 50s. They have us do fecal samples instead.

 

[tvguy]

Odd our health plan has never recommended colonoscopies and we are in our 50s. They have us do fecal samples instead.

The thinking now is to have colonoscopies starting at age 45. Someone overseeing my Doctor's medical group sent me one of those home fecal test kits, and he was NOT happy. Everything turned out fine with the kit, but at that point he ordered a colonoscopy. I was 53, and the gastroenterologist did ask why I didn't have it at 45. He seemed surprised my Primary care Doctor waited so long to order one. My health plan considers it a normal preventative procedure beginning at age 45 if you have no risk factors.

 

[tvguy]

Depending on what you are on the Eliquis for and your risk factors for another clot, you may need alternative medication during the time you are holding the Eliquis and it may be an injectable medication that requires education. That is probably why your doctor is making you come in for a consultation.

I'm not a Doctor but Eliquis IS the mildest blood thinner, even milder than baby aspirin. Not sure there are gentler options. I take it, and I did not have to stop taking it for my colonoscopy.