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Trying to convince PCP to allow colonoscopy - update

AceSFO's picture
AceSFO
Posts: 230
Joined: Sep 2009

I've got an appointment to meet with my PCP next week to try to convince him to allow a colonoscopy for me at age 45. I told his nurse that my mother has a history of pre-cancerous polyps, that there's occasional blood, and lots of cancer in my family, and even with that they said I'm way too young, but they're willing to talk to me.

I'm noticing how many people on this board were dx'd long before they turned 50, and when John was dx'd at age 49 they told him his tumor had been growing for several years and that if he had gotten scoped at age 43 they could have done more for him.

Any advice would be appreciated.

Thanks,
Adrian

tnstudent's picture
tnstudent
Posts: 45
Joined: Aug 2009

Adrian,

Not sure what to tell you other than stress to your doc that you have pre-existing factors that you are worried about. James was diagnosed at 47 and had no pre-existing conditions. If your doc thinks it is not important show his this board and thus your concerns. I wish you all the best. I am encouraging everyone that can to get tested.

Good luck,

Amy

iluvmms's picture
iluvmms
Posts: 134
Joined: Aug 2009

I was dx 3 months ago at age 38 and they said it had been there for several years probably. I am trying to get anyone with any symptoms to go and get a colonoscopy. It is rediculos that insurance companys come up with a age and say your not at risk until 55. Please push the issue with your PCP. I skipped that step and went straight to a gastro, but my insurance is probably different.

Christy

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi Adrian,

At age 45 with a family history of precancerous polyps, you definitely should qualify right away to get a colonoscopy. It's frustrating to hear the recommendations are still to "have your colonoscopy by age 50". It's actually age 40 if you have family history of this- make sure you state that to your doctor's office. I was diagnosed stage IV at age 40 & was told it was probably in me for up to 7-8 years & I have no family history whatsoever of any kind of cancer. My oncologist, colorectal surgeon, and primary care doctor have all stated to me that there's been a definite increase in the past 5 years with people under age 50 being diagnosed with colorectal cancer- especially rectal cancer. It's generally lumped together with colon cancer, but having adenocarcinoma in the rectum vs. colon is especially being found more often in younger people lately. My primary care doctor now routinely tests patients starting at age 40 with the fecal blood occult test and the bloodtest also (sorry- forgot the name of the bloodtest). She said she just started routinely adding that to the bloodwork panel requested when patients get their annual physicals (starting at age 40). She did this because of the increased incidence of younger patients being diagnosed.

Hope you get that colonoscopy and best wishes to you- you've got more than enough to worry and think about with your partner having this. Hopefully you'll be found to be just fine, but as you know, if there is something there it's always better to find it as early as possible.

Take care-
Lisa

coloCan
Posts: 1956
Joined: Oct 2009

Adrian;
Remember:Cancer does not know how old you are nor does it care!!!! It doesn't discriminate.Based upon your reasons, INSIST upon a colonoscope. The life you save will be your own.....Steve (don't be like me--I waited waaaaaaaay toooooo long and now am suffering the consequences. )

angelsbaby's picture
angelsbaby
Posts: 1171
Joined: May 2008

My dr office would do it with out insurance for 2200.00 .

CanadaSue's picture
CanadaSue
Posts: 340
Joined: Apr 2006

Adrian,

Push your doctor for the test! If there is any family history they should do the test, especially with much younger people being dx'd every day.

My husband was dx'd at 47 and they said he more than likely had the cancer for 8 - 10 years. They will start testing our daughter next year when she turns 30.

Be persistent!

HUGS,

Sue

PGLGreg's picture
PGLGreg
Posts: 741
Joined: Jul 2006

There might be some difference whether your pcp is going to allow it, or recommend it, or prescribe it. He might not be willing to recommend it, but if you've decided you definitely want one, I doubt he'd stand in the way. He might not be able to prescribe it as medically necessary, and that might prevent your insurance paying for it.

It might be better to find a gastroenterologist to do your colonoscopy -- they are supposed to be better at finding tumors.

I suppose you've realized that the frequency of young cancer victims who post here is at least in part due to the fact that young people who didn't have screening colonoscopies and didn't get cancer have no reason to post.

--Greg

Kathryn_in_MN's picture
Kathryn_in_MN
Posts: 1258
Joined: Sep 2009

I'm going to take a hard stance here.

Time for a new primary doctor if he won't listen to you on this and learn. Period. He isn't up to date on this issue. You can give him my story - my "IBS" dx because I was younger than 50, vegetarian, non-smoker, not overweight. My pain, blood in my stool, thinning of my stool, and other complaints were written off. I was not aware (nor was my family) that if a first-degree relative has adenomatous polpys that screening should start at age 40, or 10 years younger, whichever is less. If I had known this, I wouldn't be sitting where I am now. If my doctor had known this, I wouldn't be sitting where I am now. My mother has had that type of polyp at every screening starting at age 50. She is 69 now. She has never had colon cancer, but gets polyps removed every time. My siblings and I should have started screening at age 40.

Please print out the guidelines below and hand them to him. Give him my story. Give him the story of others here that are oh so similar. And remind him that no one in their right mind would ASK for a colonoscopy unless they had real reason to fear something was wrong. He should listen to you. Then if he still won't listen - time for a new doctor.

Patients with greater than average risk
“Moderate Risk”
•First degree relatives with colorectal cancer or adenomatous polyps –Start screening at age 40 or 10-15 yrs younger than affected relative
•Patients with personal history of breast, endometrial, or ovarian cancer
•Long-standing IBD/colitis( > 8 yrs)

Colorectal cancer is a significant source of morbidity, mortality, and societal cost and is largely preventable!
•Screening and surveillance prevents cancer
•Screening should begin age 40-50 + continue for life –Earlier for patients at higher risk •
Options exist, tailor recommendations to patient
•Not screening is not an option

AceSFO's picture
AceSFO
Posts: 230
Joined: Sep 2009

Great info! Thank you all very much! I did not know about the screening at age 40 for first degree relatives. Apparently he doesn't know about that either, but that's about to change. I also plan to remind him that John had gone to see him a full year before his initial dx and the doc wrote it off as IBS at that time because John had no family history.

I did find some stats on the internet that if you have a first degree relative with polyps, you have a 60% greater chance of developing the same at an earlier age. I plan to tell him about that too. I like him and think he's a good doctor, I just think he might be between a rock and a hard place with the insurance companies.

And not to get too far off topic, but speaking of insurance in America, check out this interesting bit of information that Congressman Weiner from New York came up with:

http://weiner.house.gov/news_display.aspx?id=1364

Thanks again - and I'll let you guys know how it goes.
Adrian

PGLGreg's picture
PGLGreg
Posts: 741
Joined: Jul 2006

Congressman Weiner's bit is more in the nature of propaganda than honest information. I recommend looking, in addition, at the Wikipedia entry for the public option.
--Greg

jen58
Posts: 34
Joined: Oct 2009

for people like my hubby, we were told, get scoped every 3-5 yrs, he'd been getting screened since 2002 when he was 36... he went 3 times before 2002/2009 -- Sept 09 being the last one, and now has stage III cancer, because he really should have been screened every 2 years at the age of 20 and every year after age 40 -- his former GI didn't know that either, and my hubby's cancer is very rapidly growing and he only had his for about 2 yrs.

tell your doctor in no uncertain terms, that you are demanding a screening and if he doesnt', you are moving on.

he is NOT a good doctor if he wont listen to you! it's your body, your life, INSIST upon it.

thready's picture
thready
Posts: 475
Joined: Sep 2009

Adrian,
If your PCP does not want to allow the colonoscopy because of insurance reasons, remember that all insurance companies are required to have a person Omnsbudsman (sp) for you to complain too. You can also write a letter of protest and make sure you send it to your states insurance governing body. It gets really old having the insurance tell us we can not have tests we need just because they are protecting their bottom line. Just think how much money you would save the insurance company if they found a problem before it turned into a life threatening issue!

If there is just an issue with the PCP being stuborn make sure you stress the 1st degree relative with precancer. If she had not had her colonoscopy she would have progressed to cancer. I think if you have a 1st degree relative who has had a polyp which is precancer you get a colonoscopy at age 40. I googled this and that is what I think I am reading.

Best wishes and make sure you don't take no for an answer. As we read on this board about so many who have been told that they have hemorroids when they actually had tumors growing.

We are in your corner!
Jan

cbcardb12
Posts: 85
Joined: Mar 2009

Hi Adrian,

My husband (58 years old) was diagnosed in 3/09 with stage 4 rectal cancer with multiple mets in his liver. He has been responding very well to treatment, so we are very thankful for that. He was been asking me for several months to get a colonoscopy because I will turn 50 on 11/3. Well, I had my consultation today for my colonoscopy & endoscopy (GERD patient). As I was talking to the dr & discussing my husband, he told me that their biggest fear is not catching colon cancer in time, and that part of what they have changed is that they now recommend having the first colonoscopy at 45, and to have them every 3 years after that. We are in Georgia & are one of the few states that advises folks to have colonoscopies. Also, when I set up my office visit, I asked if I would be responsible for paying an up front amount before having the test. I had heard people say that they have had to pay up to $500. I was told that they consider the first colonoscopy as important as a mammogram, kind of like preventative maintenance, that I would not be charged anything! I would stay on your dr & insurance company. Also, we were told that our son would have to start having colonoscopies 10 younger than my husband was when he was diagnosed (so 48), but he should probably start in his late thirties. Given your family history, you may be able to get one now. Good luck.

Carolyn

mommyof2kds's picture
mommyof2kds
Posts: 522
Joined: Mar 2009

I would keep at them. I was 35 at diagnosis..

NWGirl
Posts: 124
Joined: Jan 2008

You can try to educate your PCP, but I wouldn't waste too much time on it. If he/she won't listen - find a PCP who will. It was the Nurse Practitioner at my OB/GYN's office who I first met with - she saw that my father had colon cancer - and she made a HUGE deal about getting tested - 50 at the very latest; earlier if I had ANY symptoms. Well, I had symptoms - rectal bleeding that was getting worse. I was diagnosed at age 43 with a tumor "bigger than a golf ball, smaller than a grapefruit" and 27 of 38 nodes affected. I doubt that I'd have made it to 50 left untreated. My Nurse Practitioner took my symptoms very seriously as did the colo-rectal surgeon she referred me to for a colonoscopy. Thanks to their diligence, I'm still here.

I've since been tested - my cancer doesn't appear to be hereditary; I just have bad luck. I'll say it again - if this doctor won't listen, find one that will and fast. 45 is not too young - cancer doesn't seem to be too respectful of minimum age requirements.

tiny one
Posts: 467
Joined: Jan 2009

I ignored blood in my stool for about 8 years. Finally I went in and saw a Doctor when I was having alot of fatique. They found a cancerous polyp, I was told I was stage 3 colon cancer. I was 47 when I was diagnosed. My Dad had polyp's.

booboo1964
Posts: 7
Joined: Oct 2009

tell your m.d. you pass blood and have bloating.. I was 44 when dx'd ...my m.d. wanted me to have a colonoscopy for my symptoms and I had put it off for 2 years ! They estimated my cancer had been growing since i was 38-40 years old.

robinvan's picture
robinvan
Posts: 1014
Joined: May 2007

Hi Adrian,
Missed your post when it first came up. Blood in stool, even ocassionally, should be grounds enough for an investigation. It was my only presenting symptom and ignored, by me, for too long. Lot's of good advice upstream. Bottom line... get the scope!

Rob; in Vancouver

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

I think he's on PCP. Ask him to remove his head from his own rear end and put a colonoscopy scope up your rear end.

You have many factors that are warning signs Adrian. I'm not trying to alarm you but there's the family cancer history, your Mom's polyps and the blood in your stool. What does this guy need to see in order for you to get one?

Don't stop pushing for it, there is NO reason he should deny you.
-phil

AceSFO's picture
AceSFO
Posts: 230
Joined: Sep 2009

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

Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

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!

John23's picture
John23
Posts: 2140
Joined: Jan 2007

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.

Sonia32's picture
Sonia32
Posts: 1078
Joined: Mar 2009

But I relly hope you can convince your pcp to allow the colonscopy. Sending good thoughts and vibes your way.
Hugs Sonia

John23's picture
John23
Posts: 2140
Joined: Jan 2007

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.

AceSFO's picture
AceSFO
Posts: 230
Joined: Sep 2009

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

Kathryn_in_MN's picture
Kathryn_in_MN
Posts: 1258
Joined: Sep 2009

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?

heatherstar70's picture
heatherstar70
Posts: 39
Joined: Sep 2009

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

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

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's picture
PGLGreg
Posts: 741
Joined: Jul 2006

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's picture
PhillieG
Posts: 4912
Joined: May 2005

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!

amyboston's picture
amyboston
Posts: 92
Joined: Oct 2009

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

snommintj's picture
snommintj
Posts: 602
Joined: Mar 2009

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.

sfmarie's picture
sfmarie
Posts: 605
Joined: Aug 2009

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
Posts: 163
Joined: Apr 2009

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

luckyman
Posts: 4
Joined: Oct 2009

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's picture
AceSFO
Posts: 230
Joined: Sep 2009

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's picture
geotina
Posts: 2123
Joined: Oct 2009

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
Posts: 1530
Joined: Jun 2009

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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