I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake.
When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically necessary to have a colonoscopy without it.
I'm 45. Colonoscopies are a thing. I had a friend die at 52 two years ago after he was diagnosed with stage IV during his first colonoscopy. I spent many of his last days watching him struggle to survive; I don't want that to happen to me just because UHC charges me $2000/month in premiums and denies basic service because they need to pay their executives too much money.
I'm an anesthesiologist. What they denied was paying me to do it. You can still get "moderate sedation" from a nurse - a benzodiazepine and opioid.
Patients strongly prefer having what amounts to a general anesthetic; your chances of recalling anything are low either way, but propofol results in a much faster recovery to full consciousness afterward.
Go gain 100 pounds and develop sleep apnea. Then they'll approve it.
Propofol (or equivalent) is a must. I know people who have had a colonoscopy without it, and have regretted it due to significant pain.
Note that they approved the colonoscopy, just not the anesthetic. Also, to get approval for a colonoscopy, one just needs to have persistent intestinal pain or note that they have a history of polyps.
I am well aware of the colonoscopy rules. I struggle with them when patients who would not meet the standard are scheduled with us because they are employees of the hospital and it will not pay for care outside the system. It is one of the many factors that goes into the hospital’s subsidy to my group. Most of these are too ill to be done in a non-hospital facility - though most do fine and go home, there are some we have to admit overnight for observation.
It is almost universal that hospitals pay from their fees for part of the anesthesia services because the direct reimbursement we get is so low.
You can get one at 45, no questions asked, or you can claim you had a bloody stool.
As far as pain, that’s hard to measure. Procedures that are done under sedation or anesthesia in the US are done in other countries with little or nothing. I had all of my wisdom teeth extracted and all of my dental fillings done under local anesthesia only. It was fine. I don’t need gas, I don’t need sedatives.
> I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake.
It sounds like something is getting lost in translation. Presence or absence of anesthesia does not change the medical necessity of the procedure.
> I'm 45. Colonoscopies are a thing. I had a friend die at 52 two years ago after he was diagnosed with stage IV during his first colonoscopy.
Without wading into the specifics of your situation, there's not great evidence justifying colonoscopy for normal people without family history at age 45. The USPSTF just kinda lowered the threshold based on crappy (pun not intended) observational data. And if you look at their recommendations, they actually don't recommend colonoscopy, specifically -- they just recommend "screening" [1] which includes FIT, DNA testing (again: not great evidence here), or flex sig, which is done without anesthesia, and all of which are cheaper than colonoscopy. It's a huge debate.
Anyway, I absolutely don't want to reflexively defend the health insurance industry in the US, but one the reasons we have skyrocketing health care costs in this country is because people are doing expensive procedures when cheaper ones would suffice.
When my doctor recommended mine, she said that they could do screening but if they found anything, they would have to do a colonoscopy and then it wouldn’t just be covered as screening (since it was an incident rather than preventive at that point). She said it was better just to get the colonoscopy due to health insurer rules.
If they find something suspicious during the colonoscopy, they won't bill it as a free screening anymore and you'll be on the hook for it. Ask me how I know.
No regrets about getting screened though. It saved my life.
Sorry, I meant: if you do a non-colonscopy screening first and they find something, the follow up colonscopy isn't covered as preventive. And the non-colonscopy screenings have a higher false positive rate than a colonscopy screening.
Good to know. I was just adding to what you said that even if you don't get a positive result before a colonoscopy, the colonoscopy might not be covered as preventative care. Insurance just really doesn't want to cover it.
> It wouldn’t just be covered as screening (since it was an incident rather than preventive at that point). She said it was better just to get the colonoscopy due to health insurer rules.
Well yeah...it isn't screening then. It's a treatment. So the question becomes whether or not the treatment is necessary. If the prior "screening" didn't show definitive evidence that the treatment is necessary, then...what are you doing, exactly?
I understand that colonoscopies mix up the notion of treatment and screening, but the doctor is basically saying "our screening tests don't work very well, so we should just do the treatment without evidence because they'll pay for that."
Fair enough. I'm making a broader argument than just your situation (which obviously I don't know). The insurance companies are not crazy for trying to control costs on this kind of stuff...however ham-handed their methods.
I get that, but my point is that in health insurance, you're pretty much always going to find someone complaining about being denied for something, even if the denial was completely justified on an evidentiary basis (again: not talking about OP specifically here). Literally every cost-control measure -- even if sensible -- is going to be framed as evil by someone.
A lot of health care is just really expensive superstition. For a more extreme version, consider the phenomenon of "preventative MRIs", which are just lighting piles of money on fire for no reason at all.
I replied to colonoscopy specifically here because the general public has been conditioned to believe that these screenings are medically necessary at increasingly younger ages for everyone, despite the fact that this is not the standard at all in most other countries.
But it's not usual to have an anesthetic for a colonoscopy is it? I've had two without. I was offered a light sedation but then I couldn't have driven home afterwards. It wasn't particularly awful without.
It's it usual to be asleep? I've not really heard of that. Is it a US thing?
I'm not a medical doctor, nor a clinician that does colonoscopies, so I have no idea. All I know is that the clinic suggested by my primary care physician set everything up and UHC denied it 10 days prior to the procedure, leaving me almost no time to work through any sort of processes to effectively change their decision--if it's even possible.
Without any real evidence except a hunch, I think it's because I've already met my deductible for the year and they don't want to pay for the entire thing and they'll do anything they can to avoid having it happen this year and hope I just go away or do it in another year when I haven't hit my deductible.
Same here, just had one in the US and I refused to be sedated as I knew from previous one in EU that it is tolerable. You should have seen the song and dance of the provider trying to convince me to get sedated. In the end they accepted my decision. Afterwards about everybody in the clinic came to see me as if I was a hero of sorts. However,the whole episode gave me a good insight as to why US healthcare is so expensive.
> Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness.
"General anesthesia" is probably what you're thinking, which is a specific form of anesthesia where someone is put to sleep.
i was actually confused about this for a long time - i always thought my colonoscopies were "general" because i... couldn't remember anything, but all of them were really just propofol "twilight," which is just a deep sleep, i guess? i only learned this when i got a real surgery and had to actually go under general, it's a much more involved thing where you're essentially put in a coma
i'm not sure if it's a US thing but i think especially if they're going to take biopsies you're put under twilight, which is one step below general - i don't remember anything about any of the ones i've had, and wake up later in a recovery room
I'm in US and I've had a single one. It was sedation which induces twilight sleep but I was definitely conscious. I've known many that have had them (ex-partner had stage 3 colon cancer and had/has them on the regular) and it was always sedation.
I dunno if it's unusual? I had mine done recently, 49 years old... seemed like a given that I was going to go under? (I'm pretty sure I prefer it that way?)
Also UHC fwiw, but went through my local provider group, etc...
It is extremely common in the US. The only people who get colonoscopies without any sedation are those who want to be able to drive themselves home afterward.
We have people - covered in tattoos - who insist that they are terrified of needles. And that they want drugs before any even mildly painful procedure, like placing an IV.
I've done a colonoscopy without anesthesia before... it was a non-event. This is pretty common from what I understand elsewhere in the world. Americans are just super uncomfortable with their bodies so I guess we prefer being put under?
> I've done a colonoscopy without anesthesia before... it was a non-event. This is pretty common from what I understand elsewhere in the world. Americans are just super uncomfortable with their bodies so I guess we prefer being put under?
It depends on what they do while they’re in there. If they’re just taking pictures then it’s fine. If they find anything they usually cut it out immediately. I can tell you from experience that having a piece of inflamed colon cut of and cauterized while you’re conscious isn’t a “non-event” as cool as it might be to watch on the monitor.
Good god. I went to get one, and in the pre-screening, the anesthesiologist asked if I wanted to be awake for it. “Doc, I don’t want to be awake, I don’t want to feel a thing, and I don’t want to remember a thing. Put me out.”
Requiring people to be awake is a good way to guarantee they don’t get the procedure. Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expenses, erasing their profiteering.
that's insane! everyone should get a colonoscopy, and i believe they're recommending them for people over 40 if you meet certain risk categories
signed up for an account with my real name to share a doc i've been working on for a long, long time now - i've had UC since high school, and have written an extensive guide of what i've learned, if it helps you or anyone else you know who might be getting scoped:
It's estimated by CRUK there are 44,000 bowel cancer cases each year in the UK. Assuming only people over 40 get it, and that's about half the population, the incidence is something like 1 in 800 annually. The rate of "serious complications" for a colonoscopy is about 1 in 300.
Given those numbers, how often should everyone get a colonoscopy?
That's before we get on to the potential harm from a false diagnosis (which is much higher without additional priors).
Yes, absolutely people should pay attention to their bowels and get a colonoscopy when it's indicated. Let's not all rush to get one though unless there's some reason for it.
to be clear, i'm not a doctor or an expert, just a person with gasto problems - maybe to elaborate a little from my original comment: i think everyone over 40 should be screened (with a colonoscopy or other non-procedure testing) for colon cancer, full stop. then, say, every five or ten years depending on the results?
i also believe pre-screening (stool sample testing, mostly) is getting better, which would potentially help categorize who does and does not need an actual colonoscopy in the future
these are all US stats[0], which i'd imagine is a broadly worse-off group than the UK in terms of like, ultraprocessed foods and other risk factors, but this stood out to me:
> Lifetime Risk of Developing Cancer: Approximately 4.0 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetime, based on 2018–2021 data, excluding 2020 due to COVID.
anecdotally, i think with gastro problems there's a lot of individual latitude where serious problems might go undetected, under-reported, or assumed to have a less serious cause - i also think (but do not know) that colon cancer develops slowly, which may mean there's a long potential where it could be caught, detected, or risks flagged early by a colonoscopy, which, to me, outweighs the risks of "serious complications" from the procedure
They should make anyone who denies anesthesia for a colonoscopy drink that awful orange flavored drink you take the night before. This is just like... basic care.
It is really common to be out on full anesthesia for a colonoscopy. I’m confused by your comment. At least in the USA, I think it is standard and they don’t really talk about any other options.
I am in former soviet country. My relative is refusing to go for optional surgery, bcos they would put her under full anesthesia. She already had "too many anesthesias" in her life, and her brain may not take it well.
Anesthesia in many cultures is seen as a "drug use" and avoided. It has several risks, including death. In many cases it includes needle into backbone.
I’ve only been under twice: did a colonoscopy and for wisdom teeth removal. In both cases, it was simply finding a vein on my arm and I was out cold pretty quickly with a weird gap in memory when I came back. It didn’t sound like taking a risk, at least as it was sold to me.
I think we're confusing general anesthesia (not generally used for colonoscopies in the US) with sedation with something like propofol which is pretty common.
They found cancer in my colon during a follow-up for a ruptured appendix, several years before the age for recommended colonoscopies. I recently had one and asked they go light on the anesthesia, so I was in and out. They removed a polyp while I was awake and it was pretty uncomfortable. The idea that you shouldn’t even have that much anesthesia is insane. These people are morally bankrupt and frankly I don’t care what it takes to stop them.
I'm going to be a bit contrarian and say that drinking that awful liquid the evening before the procedure is 100x worse than not doing it with anesthesia. I did my colonoscopy without any anesthesia, and while it's not very pleasant, it's not painful, it's just a very weird sensation.
When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically necessary to have a colonoscopy without it.
I'm 45. Colonoscopies are a thing. I had a friend die at 52 two years ago after he was diagnosed with stage IV during his first colonoscopy. I spent many of his last days watching him struggle to survive; I don't want that to happen to me just because UHC charges me $2000/month in premiums and denies basic service because they need to pay their executives too much money.