Trying to convince PCP to allow colonoscopy - update

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  • Nana b
    Nana b Member Posts: 3,030 Member
    #22
    AceSFO said:

    Thanks
    Hey Phil - great reply - I laughed out loud when I read the first sentence, and no, I'm not alarmed but I do want to be pro-active in this. I was really surprised when I called and the nurse told me that despite what I had said (mother w/ polyps, blood) that I was still too young. She said he was still willing to meet with me though and I have an appointment for next week. I won't take no for an answer.

    Thanks to everyone who responded - I really appreciate it! This is a wonderful community -
    Adrian

    GET ANGRY!
    I had to get very angry with my pcp to get my referral, and she is now history. Told me to go home and do some situps and release some gas. She thought that was the cure for the pain on my side and the lunp that was there. Should sue her for malpractice!
  • Sonia32
    Sonia32 Member Posts: 1,071 Member
    #23
    Can't give you any advice
    But I relly hope you can convince your pcp to allow the colonscopy. Sending good thoughts and vibes your way.
    Hugs Sonia
  • John23
    John23 Member Posts: 2,122 Member
    #24
    PCP?

    You have me curious as to why you're asking a primary care doc
    for a colonoscopy?

    Make an appointment with a gastrointestinal specialist, and ask
    for a colonoscopy. There are plenty of doctors and specialists
    that are not members of a "group"; who take patients regularly
    without some other practitioner's pre-screening. Who would know
    better if you need a colonoscopy - A PCP or a gastrointestinal doc?

    If I need a specific test, I go to a specialist. If the specialist finds
    my requested procedure necessary, he provides the data to the
    insurance company.

    At worst case, I would sooner pay for it "out of pocket", than
    suffer at the hands of an incompetent physician.


    Good luck.
  • amyboston
    amyboston Member Posts: 91
    #25
    Sending positive vibes your way
    Adrian,
    I would just say to stress all the factors to your PCP Doctor. Maybe she or he would go ahead and ok the test.

    Anyway my thoughts and prayers will be with you today.

    Blessings,
    Amy
  • AceSFO
    AceSFO Member Posts: 229
    #26
    John23 said:

    PCP?

    You have me curious as to why you're asking a primary care doc
    for a colonoscopy?

    Make an appointment with a gastrointestinal specialist, and ask
    for a colonoscopy. There are plenty of doctors and specialists
    that are not members of a "group"; who take patients regularly
    without some other practitioner's pre-screening. Who would know
    better if you need a colonoscopy - A PCP or a gastrointestinal doc?

    If I need a specific test, I go to a specialist. If the specialist finds
    my requested procedure necessary, he provides the data to the
    insurance company.

    At worst case, I would sooner pay for it "out of pocket", than
    suffer at the hands of an incompetent physician.


    Good luck.

    HMO
    Hi, John, the HMO makes me go through my PCP for everything. It's crazy, but that's how it works. Somehow they seem to think it saves them money to have me meet with two different doctors rather than just go to the specialist.
    If I can get him to give me the referral to a GI doc then the HMO will pay for it. And I'm going to dig my heels in and not take "no" for an answer. I got a lot of great information from the folks on this board and I'll go in to the appointment well-armed. And like Kathryn said, "who in their right mind would ask for a colonoscopy if they didn't have good reason?"

    Thanks to all of you! I'll let you know how the appt. next week goes.

    Adrian
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #27
    John23 said:

    PCP?

    You have me curious as to why you're asking a primary care doc
    for a colonoscopy?

    Make an appointment with a gastrointestinal specialist, and ask
    for a colonoscopy. There are plenty of doctors and specialists
    that are not members of a "group"; who take patients regularly
    without some other practitioner's pre-screening. Who would know
    better if you need a colonoscopy - A PCP or a gastrointestinal doc?

    If I need a specific test, I go to a specialist. If the specialist finds
    my requested procedure necessary, he provides the data to the
    insurance company.

    At worst case, I would sooner pay for it "out of pocket", than
    suffer at the hands of an incompetent physician.


    Good luck.

    HMO?
    Possibly it has to be pre-approved by his PCP in order to have it covered by insurance. I'm in a different type plan so I don't know but when I was in a HMO you needed referrals for EVERYTHING.
    If push came to shove I'd pay of of pocket too but you have to pay through the A$$ for these procedures!
    -p
  • PGLGreg
    PGLGreg Member Posts: 731
    #28
    PhillieG said:

    HMO?
    Possibly it has to be pre-approved by his PCP in order to have it covered by insurance. I'm in a different type plan so I don't know but when I was in a HMO you needed referrals for EVERYTHING.
    If push came to shove I'd pay of of pocket too but you have to pay through the A$$ for these procedures!
    -p

    HMO?
    It's not only HMOs that require referral by your PCP. My health system (HMSA) offered me the chance to switch plans to such a system, about a year ago. I guess they must count a doctor's referrals, and if the number is large, apply some sort of penalty, to reduce referrals and hence their costs.

    --Greg
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #29
    PGLGreg said:

    HMO?
    It's not only HMOs that require referral by your PCP. My health system (HMSA) offered me the chance to switch plans to such a system, about a year ago. I guess they must count a doctor's referrals, and if the number is large, apply some sort of penalty, to reduce referrals and hence their costs.

    --Greg

    POS
    I'm in a POS plan so I don't need do deal with the referrals.
    Like I said, it's been a while since I've had to deal with it (thankfully). It seems to be a faulty system in my opinion. If you already know that you need to see a certain doctor, why do you need a note from your PCP who can't provide the service you need to allow you to see the doctor that you already know can provide you with the service?
    Gee, I'm starting to sound like the insurance companies!
  • John23
    John23 Member Posts: 2,122 Member
    #30
    Nana b said:

    GET ANGRY!
    I had to get very angry with my pcp to get my referral, and she is now history. Told me to go home and do some situps and release some gas. She thought that was the cure for the pain on my side and the lunp that was there. Should sue her for malpractice!

    Holidays are coming!
    Nana b -

    Re:
    "Told me to go home and do some situps and release some gas. She
    thought that was the cure for the pain on my side and the lunp
    that was there. Should sue her for malpractice!"

    Better to make a meatloaf out of that tumor and give it to her as a gift.
  • snommintj
    snommintj Member Posts: 601
    #31
    amyboston said:

    Sending positive vibes your way
    Adrian,
    I would just say to stress all the factors to your PCP Doctor. Maybe she or he would go ahead and ok the test.

    Anyway my thoughts and prayers will be with you today.

    Blessings,
    Amy

    Just pay for it yourself
    Shop around, you may have to talk to 20 Drs to get a good deal. Let them know that you can work on their schedule and when they have an opening you have an opening (funny, pun intended). Let them know you're paying cash and see if he can get the drug rep to front some dope for you. I did this for my brother when I was first diagnosed, he didn't have any insurance. I was diagnosed at 34 and the Dr said I had had it for 3-4 years. My little brother was 31. I got him in and out the door for less than $3500.00. He had one polyp removed and I was happy to spend the money.
  • Kathryn_in_MN
    Kathryn_in_MN Member Posts: 1,252 Member
    #32
    AceSFO said:

    HMO
    Hi, John, the HMO makes me go through my PCP for everything. It's crazy, but that's how it works. Somehow they seem to think it saves them money to have me meet with two different doctors rather than just go to the specialist.
    If I can get him to give me the referral to a GI doc then the HMO will pay for it. And I'm going to dig my heels in and not take "no" for an answer. I got a lot of great information from the folks on this board and I'll go in to the appointment well-armed. And like Kathryn said, "who in their right mind would ask for a colonoscopy if they didn't have good reason?"

    Thanks to all of you! I'll let you know how the appt. next week goes.

    Adrian

    You may also want to pull up
    You may also want to pull up some studies on what an advanced colon cancer patient costs to treat for the disease vs what a colonoscopy costs. If the trouble is insurance company bottom line, they are much better off catching you earlier than later...

    And it might not be cancer, but something else that needs attention which would cost less now than not dx'ing till later. Collitis, Chron's, diverticulitus and other bowel diseases can cause blood in the stool and discomfort. (My CT radiologist said that I had probable mild colitis with a few reactive lymph nodes... that is what got me my colonoscopy in the end.) SURPRISE - not colitis - and those lymph nodes were reacting all right!

    I hope whatever is causing your troubles is something very simple. But the only way to find out is more testing. You NEED to have testing done. Have they done anything?
  • sfmarie
    sfmarie Member Posts: 602
    #33
    Here is what I did
    My sister, 39 years old, was dx 03/09 stage IV. I am 44, and told my PCP that my sister was just dx. I was approved for my colonoscopy, no questions asked beyond what I said.
    Good luck!
    Marie
  • serrana
    serrana Member Posts: 163 Member
    #34
    sfmarie said:

    Here is what I did
    My sister, 39 years old, was dx 03/09 stage IV. I am 44, and told my PCP that my sister was just dx. I was approved for my colonoscopy, no questions asked beyond what I said.
    Good luck!
    Marie

    Don't back down
    Every time your PCP orders a test it reduces his income; HMO's contract w/ PCPs for a set amount of money per year per patient, more tests? less money.
    If your PCP is not up on the latest statistics re occurance of CRC then send a registered letter to the HMO administration with a copy to the PCP appealing the decision. They will say no again.
    Then send a registered letter to your state department of insurance HMO division. with copies to the PCP and the HMO. They will help.
    Then send the stats to the largest newspaper near you and let them get a feature article about it. Then tell them you are going to sue them. You'll get your colo.
    If all this fails and I doubt that it will pay out of pocket for one, everyone needs a colonoscopy with your history and situation. The stats confirm that.
    Don't back down, it is your life
    Serrana
  • heatherstar70
    heatherstar70 Member Posts: 39
    #35
    AceSFO said:

    HMO
    Hi, John, the HMO makes me go through my PCP for everything. It's crazy, but that's how it works. Somehow they seem to think it saves them money to have me meet with two different doctors rather than just go to the specialist.
    If I can get him to give me the referral to a GI doc then the HMO will pay for it. And I'm going to dig my heels in and not take "no" for an answer. I got a lot of great information from the folks on this board and I'll go in to the appointment well-armed. And like Kathryn said, "who in their right mind would ask for a colonoscopy if they didn't have good reason?"

    Thanks to all of you! I'll let you know how the appt. next week goes.

    Adrian

    hey
    i am going today to have my first colonoscopy and i am only 27 i have no sympyoms but my mother died this past august from colorectal cancer she would have been 50 this thanksgiving.. i went to my pcp and told them what i wanted to do and they thought it was a great idea.. they sent me to the gastro dr and he also thought it was a great idea so today is the day....i hope you dont have any trouble getting them to approve this for you.. if you do fight it and if your dr doesnt seem to want to go along with you then maybe you should look into going to another dr..
    let us no how it goes

    heather
  • luckyman
    luckyman Member Posts: 4
    #36
    malpractice
    I was diagnosed at 46 and I have been told that my tumor was growing for quite some time. In fact I was stage III when diagnosed. I told my doctor that I had experienced bleeding and he insisted that I get a colonoscopy immediately. It does not matter that you are under the age of fifty particularly with family history and symptoms. As an attorney I believe that a malpractice case would be fairly simple to make out of the simple negligence of a doctor that refuses a necessary procedure because your'e too young. Rund dont walk to find another physician that takes your health more seriously. I didn't always care for my PCP...until he saved my life. Good luck.
  • AceSFO
    AceSFO Member Posts: 229
    #37
    Met with PCP this morning
    and he's all for having me scoped. I didn't have to go into the stats and other info I gathered from you guys - he was on board from the get-go. He already had it in his notes that my mother had her first pre-cancerous polyp removed at age 53. Now the next step is to meet with the GI doc and hope that he feels the same way, and if so, then we can schedule the colonoscopy. Woo Hoo!!

    Thanks again to everyone who responded - I really appreciate it, and I'll let you know what happens when I finally get scoped.

    Adrian
  • geotina
    geotina Member Posts: 2,111 Member
    #38
    AceSFO said:

    Met with PCP this morning
    and he's all for having me scoped. I didn't have to go into the stats and other info I gathered from you guys - he was on board from the get-go. He already had it in his notes that my mother had her first pre-cancerous polyp removed at age 53. Now the next step is to meet with the GI doc and hope that he feels the same way, and if so, then we can schedule the colonoscopy. Woo Hoo!!

    Thanks again to everyone who responded - I really appreciate it, and I'll let you know what happens when I finally get scoped.

    Adrian

    Daugher getting the test
    Hubby George was diagnosed at age 60 with Stage IV. Our daughter is 31. Our oncologist suggested she not wait too long to get her first colonoscopy. She mentioned it to her doctor and they are doing some type of genetic work up with an genetic doc and making a plan as to what tests she should have and when and how often. There is some breast cancer in George's family, mostly older women (over age 70). They are doing a complete family history on both sides. Already approved for a colonoscopy. I'm glad her doctor is pro-active in all areas of preventative health care.
  • Fight for my love
    Fight for my love Member Posts: 1,522 Member
    #39
    AceSFO said:

    Met with PCP this morning
    and he's all for having me scoped. I didn't have to go into the stats and other info I gathered from you guys - he was on board from the get-go. He already had it in his notes that my mother had her first pre-cancerous polyp removed at age 53. Now the next step is to meet with the GI doc and hope that he feels the same way, and if so, then we can schedule the colonoscopy. Woo Hoo!!

    Thanks again to everyone who responded - I really appreciate it, and I'll let you know what happens when I finally get scoped.

    Adrian

    Hi Adrian,it is good for
    Hi Adrian,it is good for you.Finally the issue is sloved.We have to be always our own advocates for our own health.Good luck with it,please keep us updated.Take care.

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