6 ms·

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 ane

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.

bschmidt11 2y ago
[flagged]
tommilburn 2y ago
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: https://docs.google.com/document/d/1bTW2rdF744woSPpFsUeSaFYauthOKQSyW4_myXUypig/edit?tab=t.0 https://docs.google.com/document/d/1bTW2rdF744woSPpFsUeSaFYa...
- deleted 2y ago
  [deleted]
- hgomersall 2y ago
  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.
  - tommilburn 2y ago
    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 [0] https://seer.cancer.gov/statfacts/html/colorect.html https://seer.cancer.gov/statfacts/html/colorect.html
jbb67 2y ago
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?
- tommilburn 2y ago
  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
- garciasn 2y ago
  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.
- tedivm 2y ago
  Light sedation is anesthesia. > 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.
  - tommilburn 2y ago
    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
kstrauser 2y ago
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.
- caseyohara 2y ago
  > for the insurer to incur enormous colon cancer treatment expenses This presupposes the insurer isn’t going to deny claims for that treatment, too.
- ziddoap 2y ago
  >Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expenses, erasing their profiteering. Just find an excuse to deny those claims, too!
  - kstrauser 2y ago
    Have you considered a lucrative career in healthcare management!
voidfunc 2y ago
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?
- chefandy 2y ago
  > 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.
harshaw 2y ago
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.
devilbunny 2y ago
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.
- deleted 2y ago
  [deleted]
- OutOfHere 2y ago
  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.
  - devilbunny 2y ago
    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.
chefandy 2y ago
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.
Noumenon72 2y ago
You were not denied a colonoscopy, but anesthesia during a colonoscopy, which is not medically necessary[1]. Tough line to draw though. 1: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/benefits-of-sedation-free-colonoscopy#:~:text=Yes.,those%20found%20on%20the%20skin https://www.mayoclinichealthsystem.org/hometown-health/speak....
- MichaelZuo 2y ago
  It does seem like the parent is confused. I haven't heard of any jurisdiction where putting someone under for colonoscopies, outside of extreme cases, is the standard expectation. Not even for fancy private hospitals, way too high of a risk-reward ratio.
  - seanmcdirmid 2y ago
    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.
    - throw9002939 2y ago
      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.
      - seanmcdirmid 2y ago
        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.
  - 2y ago
timr 2y ago
> 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. [1] https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme...
- garciasn 2y ago
  My father's mother had it. My mother's father died of it early. I am predisposed.
  - timr 2y ago
    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.
    - the_snooze 2y ago
      >The insurance companies are not crazy for trying to control costs on this kind of stuff...however ham-handed their methods. At some point, after so many failures and edge cases, the least they can do is be actual humans and ask themselves "are we the baddies?"
pnutjam 2y ago
Did they give you an option to poop in a box? I went with that.
- astura 2y ago
  Cologuard?
  - pnutjam 2y ago
    Yeah
- itishappy 2y ago
  Occult blood stool sample? Colonoscopies are a lot more accurate. Something on the order of 50% vs 90%.
bufferoverflow 2y ago
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.
- MiguelX413 2y ago
  False dilemma.
deleted 2y ago
[deleted]
deleted 2y ago
[deleted]

bschmidt11 2y ago

[flagged]

tommilburn 2y ago

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: https://docs.google.com/document/d/1bTW2rdF744woSPpFsUeSaFYauthOKQSyW4_myXUypig/edit?tab=t.0 https://docs.google.com/document/d/1bTW2rdF744woSPpFsUeSaFYa...

deleted 2y ago
[deleted]
hgomersall 2y ago
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.
- tommilburn 2y ago
  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 [0] https://seer.cancer.gov/statfacts/html/colorect.html https://seer.cancer.gov/statfacts/html/colorect.html

jbb67 2y ago

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?

tommilburn 2y ago
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
garciasn 2y ago
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.
tedivm 2y ago
Light sedation is anesthesia. > 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.
- tommilburn 2y ago
  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

kstrauser 2y ago

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.

caseyohara 2y ago
> for the insurer to incur enormous colon cancer treatment expenses This presupposes the insurer isn’t going to deny claims for that treatment, too.
ziddoap 2y ago
>Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expenses, erasing their profiteering. Just find an excuse to deny those claims, too!
- kstrauser 2y ago
  Have you considered a lucrative career in healthcare management!

voidfunc 2y ago

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?

chefandy 2y ago
> 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.

harshaw 2y ago

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.

devilbunny 2y ago

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.

deleted 2y ago
[deleted]
OutOfHere 2y ago
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.
- devilbunny 2y ago
  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.

chefandy 2y ago

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.

Noumenon72 2y ago

You were not denied a colonoscopy, but anesthesia during a colonoscopy, which is not medically necessary[1]. Tough line to draw though. 1: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/benefits-of-sedation-free-colonoscopy#:~:text=Yes.,those%20found%20on%20the%20skin https://www.mayoclinichealthsystem.org/hometown-health/speak....

MichaelZuo 2y ago
It does seem like the parent is confused. I haven't heard of any jurisdiction where putting someone under for colonoscopies, outside of extreme cases, is the standard expectation. Not even for fancy private hospitals, way too high of a risk-reward ratio.
- seanmcdirmid 2y ago
  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.
  - throw9002939 2y ago
    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.
    - seanmcdirmid 2y ago
      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.
- 2y ago

timr 2y ago

> 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. [1] https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme...

garciasn 2y ago
My father's mother had it. My mother's father died of it early. I am predisposed.
- timr 2y ago
  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.
  - the_snooze 2y ago
    >The insurance companies are not crazy for trying to control costs on this kind of stuff...however ham-handed their methods. At some point, after so many failures and edge cases, the least they can do is be actual humans and ask themselves "are we the baddies?"

pnutjam 2y ago

Did they give you an option to poop in a box? I went with that.

astura 2y ago
Cologuard?
- pnutjam 2y ago
  Yeah
itishappy 2y ago
Occult blood stool sample? Colonoscopies are a lot more accurate. Something on the order of 50% vs 90%.

bufferoverflow 2y ago

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.

MiguelX413 2y ago
False dilemma.

deleted 2y ago

[deleted]

deleted 2y ago

[deleted]