I am finally putting this down here, but it has been bugging the shit out of me since last year.

Early last year my wife got a cologuard test and submitted it. It came back as positive. No symptoms or problems other than a positive. We talked to her doctor and she indicated that false positives are common. But with all that said it sits back in the back of your mind and any little bit of irregularities seam to nag at your thoughts. She decided to have a colonoscopy done. Contacted the insurance company and was informed that because of the cologuard came back as positive the colonoscopy is no longer considered a preventative procedure! It is now an elective procedure and the copay now must be paid. WTF! So what would have cost little or nothing changes to a couple of grand. The doctor doesn’t mention this, the insurance company that pushes the cologuard test doesn’t tell you the possibility of the change of status on a claim with a positive test result.

Heads up to all of you out there electing a cologuard test instead of a colonoscopy.

FYI colonoscopy results were clear.

This is an insurance rule. Appeal it and persist. You should prevail. Your GI may have to write a letter.

Insurance rule for Cologard changed in 2023. Insurance will pay for colonoscopy after a positive Cologard in 2023. Prior to 2023, insurance would only pay for either Cologard OR colonoscopy as a screen.

I looked into Cologuard but my Doc discouraged it because of high false positives. And I have a family history of Colon Cancer.
So I went the old fashioned route. And so did a small camera!

quote:

Originally posted by SIGfourme:
Insurance rule for Cologard changed in 2023. Insurance will pay for colonoscopy after a positive Cologard in 2023. Prior to 2023, insurance would only pay for either Cologard OR colonoscopy as a screen.

That is good to know I was not aware of the rule change.

quote:

Originally posted by Ozarkwoods:
I am finally putting this down here, but it has been bugging the shit out of me since last year.
.

I know, but I have to say with the title and that as your first line it was funny.

Why not do another cologuard test and see what the results are? Then if a negative she is Goode to go... (another joke?) if it is positive then insurance will now pay for the colonoscopy.

What good is this if it gives false (either way) results? Is it accurate or not?

quote:

I looked into Cologuard but my Doc discouraged it because of high false positives. And I have a family history of Colon Cancer.

The advertising states it is not for people at high risk, which you would be.

quote:

Originally posted by egregore:
What good is this if it gives false (either way) results? Is it accurate or not?

Diagnostic tests have all have to strike a balance between sensitivity and specificity. For Cologuard, it has pretty high sensitivity for detection of disease (96%), but that comes with about a 13% false positive rate. With insurance paying for the follow up colonoscopy in the case of a false positive now, there really isn't much downside. There is a 13% chance you do the follow up for nothing. If you skip the Cologuard and go straight to the colonoscopy when you don't really have cancer, the chance is 100%.

Family history needs to be taken in context. An uncle that died of colon cancer at age 80 is an entirely different risk profile than a parent and 2 siblings that all developed colon cancer at age 45.

It is also important to realize that a colonoscopy can remove polyps and give the GI doc a clear picture of possible diverticulitis and other GI issues. Cologuard is cheaper and has been heavily marketed, but it is not the gold standard.

^^^
Gold is what it’s all about. When you see surgical centers and GI docs advertising colonoscopies, it makes you question the motivation. There are only a handful of countries that use colonoscopy as a screening tool.

Just like with cpap machines I just wonder about all this new medical you got to have it ....

How many of us 40 years ago or so would have gone somewhere and gladly had stuff jammed up our butts... well some here probably, but not me. I'm not anti gay.... just not something I want. I did do the poop in a bucket thing just to make my doctor happy.

Same thing happened to my wife.
We both took the test, hers came back positive.
She had to get a Colonoscopy which came out fine.
We had to pay a copay, not a couple grand but a few hundred $ as I recall.
It isn't right and we should never had the stupid inadequate Colonguard.