Tuesday, May 01, 2012

It's Called "Health" Insurance, Right?

As those of you who follow my blog probably know, my dad has had two battles with colon cancer, the first in 2007 and the most recent in 2011.

He is a wonderful soul, a great story-teller and an easy-going, great guy who has been through hell. From diagnosis in January 2011 to a final surgery in October, he spent most of last year battling this disease. He is now cancer-free but is taking a low-dose maintenance chemo pill right now, since this particular type of cancer has recurred once already for him.

My dad and I, April 2012.
I have had friends and family members who have had cancer of the lung, breast, bone marrow and blood, ovary, thyroid, skin, cervix and others. You name the body part, there's a cancer that can grow on it. I do not mean to minimize the hell that all cancer is, but I cannot imagine a cancer more difficult to treat and manage than colon cancer because of the loss of dignity that goes along with it. I won't get more detailed than that, except to say that if you want to know more about the challenges that go along with colon cancer, you should check out my dad's blog on the subject. He is incredibly open and detailed in sharing his experience in order to help others who may be going through it themselves. There's a lot about this particular recovery that doctors don't tell you about.

Thus I am motivated to get screened for colon cancer, even though I'm not yet at the recommended age of 50. My doctor recommended it based on my dad's history and wrote a pre-approval request to Blue Cross Blue Shield, my insurance company, that I get screened.

It was denied because I'm not yet 50, despite my family history.

Hmmm...that's odd, this same insurance company covered the same procedure for my husband when he was under 50, based on his sister's early diagnosis of colon cancer. Hers was found during a routine colonoscopy and did not need any additional treatment beyond the removal of the polyp during the screening. The biopsy of the polyp indicated that it had been cancerous, and her doctor told her she was lucky that she had gotten a colonoscopy when she did, because her doctor misread her chart and thought that she had already reached her 50th birthday. If he'd realized she was still a few years shy, he wouldn't have recommended the procedure.

They covered my husband's screening but denied mine. Odd. So I called. Twice.

The first time the "customer advocate" informed me that it was her understanding that this health screening was covered when there was a family history, and that the pre-approval had been declined because of the manner in which my healthcare provider submitted the paperwork. (Apparently there's a difference between a "routine" and a "medical" colonscopy.) She said she would call my doctor's office, have them re-submit the paperwork and that I should get approved. Great.

Two weeks later I still hadn't heard anything, so I called BCBS again to confirm that it was now approved, only to find that it has been officially and formally declined.

That's because my insurance policy does NOT cover screening colonoscopies under age 50, regardless of family history. Basically, the only way BCBS would cover a colonoscopy is if my doctor indicated that I had some symptoms that would require one; in other words, if my doctor committed fraud. Not that BCBS recommended she do that, but simply said that colonoscopies are only covered if symptoms are present. I have no symptoms, and from what I understand of the disease, by the time symptoms appear it often means cancer is present. That's why people get screened.

While I wasn't looking forward to the procedure, I was looking forward to the peace of mind of having a clean bill of health, and I'm frustrated and annoyed by this decision. We recently drained our health savings account due to appointments for other family members so we have no money set aside for this procedure, which we discovered costs around $2,500.

Our family is fortunate in that we have health insurance and we have the ability to save money on a monthly basis to cover our health expenses not covered by our high-deductible plan. Eventually I'll be able to get screened, and we'll pay for it out of our own pocket. But for low-income familes or anyone without health insurance, I have to believe that this is a screening that they would simply not get if insurance didn't pay for it.

Obviously BCBS understands that they are gambling that the majority of colonscopies performed on people under age 50, regardless of family history of colon cancer, will be negative. But if they are wrong, it doesn't seem fair that their customers get to pay the price with their health.


  1. Had my one and only colonoscopy at age 54. The Doc said I should have one as part of a regular check up. When I told him our insurance co would'nt pay for this type of routine screening, regardless of age, he said "Then I'll just say there's irregular bowel habits or blood in the stool". I don't know what he did put in his report but my colonoscopy was paid for. Fraud? I think it's just how the game is played and I suspect that's what the person you were talking to was trying to tell you.

  2. That's pretty shocking! From what I understand, if there are symptoms colon cancer is in the later stages. At least I think that's what I've learned from katie couric. That's why colonoscopies are so important. We've got colon cancer in our family too. I agree that it is one of the worst ones.

  3. The symptoms can range from pain during bowel movements to irritable bowel syndrome symptoms to bleeding from the rectum. This last time I experienced all three. The cancer had completely circled the colon following the stitch line from the original surgery. It was partially blocking the colon making BM's difficult and painful. Tumors bleed so don't take the idea with colon cancer that if you have symptoms like that it is in a stage IV condition. Mine was bleeding for about two months every time I had a BM. I thought it was hemorrhoids. Mine was diagnosed after treatment as Stage II with some other letters. The one thing we do not know is if the cancer had spread to the lymph nodes because they were destroyed during radiation. The prognosis is good, I have great faith in the doctors and I have learned enough to be watchful also. It has meant so much to have my daughters as part of my support group, my wife played such a strong role I am deeply indebted to her, and my two sisters were towers of strength. Thank you Jenny for making more people aware and do not wait till 62 like I did.