[Minimizing costs of a medical procedure (Colonoscopy)]

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kenoryan
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Re: Minimizing costs of a Colonoscopy

Post by kenoryan » Mon Mar 05, 2018 11:41 pm

SlowMovingInvestor wrote:
Sat Mar 03, 2018 7:10 pm
If something is detected during a colonoscopy, and (say) a polyp has to be removed, does that convert the colonscopy from a screening to a diagnostic, and it then becomes chargeable ?

Yes.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by TravelGeek » Tue Mar 06, 2018 1:14 am

Epsilon Delta wrote:
Mon Mar 05, 2018 4:42 pm
It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.
Maybe the patients didn’t get anesthesia, as some of the other posters here apparently chose for their procedure?

I called to get my appointment today. Was told I would need someone to drive me and stay with me. Planning to take a day off from work (appointment is first thing in the morning).

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Tue Mar 06, 2018 8:26 am

TravelGeek wrote:
Tue Mar 06, 2018 1:14 am
Epsilon Delta wrote:
Mon Mar 05, 2018 4:42 pm
It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.
Maybe the patients didn’t get anesthesia, as some of the other posters here apparently chose for their procedure?
I called to get my appointment today. Was told I would need someone to drive me and stay with me. Planning to take a day off from work (appointment is first thing in the morning).
I know that the exact sedation I have received in the more recent colonoscopies is different than what I received years/decades ago. Back then, there was one drug for pain relief (cannot remember exactly) and one for relaxation (once was Valium).

A few years ago, in this area, there was an assistant (not sure his exact credentials) for a Gastroenterologist who diverted pain medication for his own illegal use and diluted the supply used in Colonoscopies. Lots of the patients endured more pain/discomfort than they should have.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Lynette » Tue Mar 06, 2018 10:40 am

Scrapr wrote:
Mon Mar 05, 2018 12:15 am
Lynette wrote:
Sun Mar 04, 2018 5:42 pm
dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
That is also my experience with my hospital. When I check in, I'm asked who is with me. No person - no procedure. A doctor goes and chats up that person who came with me before the procedure begins and gives them some information. Generally I am in excellent health and don't care if I am put under or not. What irritates me is that I cannot take a taxi home. I do not get the opportunity to act as an adult human being.

This may indeed be for the patient's benefit but I am cynical and think that 90% of this is for the hospital to avoid medical liability.
Let me tell you my story. I am Dx w/Crohns so colonoscopy is a regular deal. Most times by my GI doc, not the factory lines ones. Although I have had a couple there. One was in a hospital w/my GI doc. I get out and into recovery and I'm not doing great. Coughing and cold. We discharge and Mrs Scrapr drives me home. I go up to bed and can't get warm. Fast shallow breathing. Call to the advice nurse and off we go to urgent care. Where I could not stand for a chest x ray. So ambulance ride to the ER. I had aspirated some vomit in the procedure into my lungs. Which caused pneumonia. 3 days in the hospital. If Mrs Scrapr had not been there I think there was a better than even chance I'd be dead

True BH fashion I negotiated the cost to be free :D
I appreciate your perspective and am pleased it worked out well for you. But as I mentioned, one has to know one's own health. In my last year of working (2 years ago) I was exempted from the mandatory wellness test as I was considered to be in excellent health. When I go for a tooth implant, I am scolded by the doctor as I refuse pain medication. I don't feel the pain as apparently I have a high tolerance for pain. I have had a few colonoscopies and a bunion operation. I recover quickly and refuse to have anyone help me to the parking lot as I don't need it. I don't drive after being driven home but feel chipier immediately. If the situation were different, I would heed medical advice but I don't get the chance to use my own judgment about my health.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Scrapr » Tue Mar 06, 2018 10:56 am

Let me tell you my story. I am Dx w/Crohns so colonoscopy is a regular deal. Most times by my GI doc, not the factory lines ones. Although I have had a couple there. One was in a hospital w/my GI doc. I get out and into recovery and I'm not doing great. Coughing and cold. We discharge and Mrs Scrapr drives me home. I go up to bed and can't get warm. Fast shallow breathing. Call to the advice nurse and off we go to urgent care. Where I could not stand for a chest x ray. So ambulance ride to the ER. I had aspirated some vomit in the procedure into my lungs. Which caused pneumonia. 3 days in the hospital. If Mrs Scrapr had not been there I think there was a better than even chance I'd be dead

True BH fashion I negotiated the cost to be free :D
[/quote]

I appreciate your perspective and am pleased it worked out well for you. But as I mentioned, one has to know one's own health. In my last year of working (2 years ago) I was exempted from the mandatory wellness test as I was considered to be in excellent health. When I go for a tooth implant, I am scolded by the doctor as I refuse pain medication. I don't feel the pain as apparently I have a high tolerance for pain. I have had a few colonoscopies and a bunion operation. I recover quickly and refuse to have anyone help me to the parking lot as I don't need it. I don't drive after being driven home but feel chipier immediately. If the situation were different, I would heed medical advice but I don't get the chance to use my own judgment about my health.
[/quote]

My point is that stuff happens. It may be fine for 10 times and the next time you are in a life emergency. It truly made me reflect. It is very hard to schedule emergencies

may all your colons be clean :D

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by duckcalldan » Tue Mar 06, 2018 6:25 pm

Had my first colonoscopy last month. Covered under ACA, zero cost. And, more importantly, zero polyps.

I didn’t have a choice to forego anesthesia. Well, I guess I did but I didn’t request it. My first experience with Propofol, very impressed that I slept for maybe 20 minutes (it was a quick scope) and no post-op grogginess.

Trivia: it’s called milk of amnesia and it’s what killed Michael Jackson. Propofol can be deadly if an anesthesiologist is not by your side monitoring vitals continuously.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by ResearchMed » Tue Mar 06, 2018 6:34 pm

duckcalldan wrote:
Tue Mar 06, 2018 6:25 pm
Had my first colonoscopy last month. Covered under ACA, zero cost. And, more importantly, zero polyps.

I didn’t have a choice to forego anesthesia. Well, I guess I did but I didn’t request it. My first experience with Propofol, very impressed that I slept for maybe 20 minutes (it was a quick scope) and no post-op grogginess.

Trivia: it’s called milk of amnesia and it’s what killed Michael Jackson. Propofol can be deadly if an anesthesiologist is not by your side monitoring vitals continuously.
Somehow, I'd never heard it called "milk of amnesia" :happy

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Tue Mar 06, 2018 8:16 pm

duckcalldan wrote:
Tue Mar 06, 2018 6:25 pm
Had my first colonoscopy last month. Covered under ACA, zero cost. And, more importantly, zero polyps.
I didn’t have a choice to forego anesthesia. Well, I guess I did but I didn’t request it. My first experience with Propofol, very impressed that I slept for maybe 20 minutes (it was a quick scope) and no post-op grogginess.
Trivia: it’s called milk of amnesia and it’s what killed Michael Jackson. Propofol can be deadly if an anesthesiologist is not by your side monitoring vitals continuously.
Yes - that is what was used for my last several.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sun Mar 11, 2018 3:08 pm

stats99 wrote:
Sun Mar 04, 2018 6:44 am
I used Cologuard.
The best colon cancer screening test is the one that gets done!

:beer
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sun Mar 11, 2018 3:14 pm

Good Listener wrote:
Sun Mar 04, 2018 3:39 pm
woof755 wrote:
Sat Mar 03, 2018 10:49 pm
Good Listener wrote:
Sat Mar 03, 2018 7:24 pm
There are 2 issues here which have been partly resolved.
1. Sedation: I have never chosen to do these without anesthesia but it is an option to just have some gentle sedation and it is done all the time.
2. Prison: they can have any rule they want. You are a free person and can simply say that you are leaving by cab or Uber and that you have somebody waiting home for you. They cannot hold you against your will. They cannot even force you to sign an against medical advice form although I would preemptively tell them I will sign it if they have it. Without handcuffs you are free to go.

I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives.

There is no such thing as "gentle sedation." Any dose of these meds can cause these amnestic effects.

People who believe they "watched the whole thing" despite receiving sedation are not aware of the part of the procedure through which they slept. It's *very* common for the patient to be sleeping comfortably during scope insertion, which can be completed in just a couple of minutes, then wake up as we are removing the scope. Almost every day a pt who slept through 75% of the procedure says at the end of it, "Wow. I thought I was going to be asleep for this. I was awake the whole time." That's cool, though. Our goal is comfort.

There are also two kinds of sedation. When the GI doc and RNs administer versed and fentanyl, the sedation is wrapped into the cost of the colonoscopy. When a nurse anesthetist is used to administer propofol, there is an additional charge from the anesthesiology provider.

It's my understanding that finding a polyp no longer makes the procedure a fully covered screening test (it used to trigger it being a diagnostic exam). This never made sense to me, because polyps are what we were screening for in the first place. Why should insurers punish the patient for having what the test is designed to look for? I believe this is a thing of the past: https://blog.aarp.org/2013/02/25/free-c ... olyps-too/

You will likely receive a bill from the pathology department for your polyp analysis, though.
I understand what you are saying. Now, let me ask. When you say that you won't let somebody go, do you mean you would physically restrain them? How would you hold them? There are AMA forms for somebody to check out of hospitals against advice and they cannot be held against their will unless I suppose a judge's order was obtained.
Omigosh we would never physically restrain anyone.
One time when the patient's driver/spouse was obviously under the influence of pain pills or anxiety medications (she spilled coffee on herself while sitting up--this is *not* the patient, it's the spouse!) we got a hotel for them across the street and called the police to ensure they didn't drive anywhere.
Nope, if someone doesn't have a responsible person to accompany, we just don't do the procedure with sedation.

The key to all of this is having excellent nursing staff doing pre-calls to make sure the patient knows exactly what the rules are so all is done safely and according to the patient's comfort level / wishes.
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Re: Minimizing costs of a Colonoscopy

Post by munemaker » Sun Mar 11, 2018 3:17 pm

kenoryan wrote:
Mon Mar 05, 2018 11:41 pm
SlowMovingInvestor wrote:
Sat Mar 03, 2018 7:10 pm
If something is detected during a colonoscopy, and (say) a polyp has to be removed, does that convert the colonscopy from a screening to a diagnostic, and it then becomes chargeable ?

Yes.
In my experience, No.

I am on ObamaCare. Had my first colonoscopy a few months ago. During the procedure, two small polyps were found and removed. Everything was covered. I paid nothing.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sun Mar 11, 2018 3:18 pm

Lynette wrote:
Sun Mar 04, 2018 5:42 pm
dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
That is also my experience with my hospital. When I check in, I'm asked who is with me. No person - no procedure. A doctor goes and chats up that person who came with me before the procedure begins and gives them some information. Generally I am in excellent health and don't care if I am put under or not. What irritates me is that I cannot take a taxi home. I do not get the opportunity to act as an adult human being.

This may indeed be for the patient's benefit but I am cynical and think that 90% of this is for the hospital to avoid medical liability.

In my opinion, this is so you don't:

a) Forget where you live or tell the cab driver some oddball address
b) get into the cab, fall back asleep and get robbed or way, way, way worse.

We're docs, we're paid to worry about the worst possible thing. :wink:
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sun Mar 11, 2018 3:22 pm

SlowMovingInvestor wrote:
Sun Mar 04, 2018 11:03 pm
One point worth mentioning is that some practices allow direct access colonoscopy -- i.e. you can have the screening colonoscopy without a previous Gastroenterologist visit. Even a referral from your regular primary doctor may not be needed if you meet the screening colonoscopy criteria.

This saves you the specialist's fee -- which could be around $200 or so for a HDHP plan.

[I am not sure if an office visit is scheduled after a screening colonoscopy if the results are normal, or if the office just calls you with the results.]
We do direct access at my current and my former job.
If patients request a visit, we'll see them.

There is no medicare billing code for a pre-procedure visit unless there are significant medical problems / medications to adjust, so there is no way for a GI to bill for a routine pre-procedure visit. I'm actually not sure if there is still a copay.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sun Mar 11, 2018 3:26 pm

dm200 wrote:
Mon Mar 05, 2018 9:04 am
Without getting too deep into the forbidden medical topics -

Are there differences in costs for different physicians that do colonoscopies? All of mine, as well as those of everyone I know in this area, have been done by Gastroenterologists. My brother, however, who still lives in the area where I grew up, told me his colonoscopies are done by a surgeon.
As long as the person doing your procedure is very qualified, it's fine. Obviously, gastroenterologists do more colonoscopies than surgeons do, and in most communities, the "community standard" is to have a GI do it. Prices are all based on what the doc has negotiated with the insurance company, or her practice has negotiated, or the university, etc.

Procedures at outpatient endo centers are cheaper for the patient than procedures at the hospital. (The doctor gets paid the same for doing the procedure)
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by VictoriaF » Sun Mar 11, 2018 3:28 pm

woof755 wrote:
Sun Mar 11, 2018 3:18 pm
We're docs, we're paid to worry about the worst possible thing. :wink:
There is a fine line between caring and patronizing. For example, most medical practitioners would try to avoid getting cardiopulmonary resuscitation but perform it on others.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sun Mar 11, 2018 7:05 pm

woof755 wrote:
Sun Mar 11, 2018 3:22 pm
SlowMovingInvestor wrote:
Sun Mar 04, 2018 11:03 pm
One point worth mentioning is that some practices allow direct access colonoscopy -- i.e. you can have the screening colonoscopy without a previous Gastroenterologist visit. Even a referral from your regular primary doctor may not be needed if you meet the screening colonoscopy criteria.
This saves you the specialist's fee -- which could be around $200 or so for a HDHP plan.
[I am not sure if an office visit is scheduled after a screening colonoscopy if the results are normal, or if the office just calls you with the results.]
We do direct access at my current and my former job.
If patients request a visit, we'll see them.
There is no medicare billing code for a pre-procedure visit unless there are significant medical problems / medications to adjust, so there is no way for a GI to bill for a routine pre-procedure visit. I'm actually not sure if there is still a copay.
OK - here is the part I do not understand. From my decades long experience as a patient, there are multiple ways of addressing the risks of Colon Cancer. In such cases where it is not clear (to the patient) what are the pros and cons of the choices, how is that done without an office visit with the Gastroenterologist? Maybe the choice is as simple as flex sig vs colonoscopy - still an office visit discussion with the Gastroenterologist, right?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Lynette » Mon Mar 12, 2018 12:39 am

woof755 wrote:
Sun Mar 11, 2018 3:18 pm
Lynette wrote:
Sun Mar 04, 2018 5:42 pm
dm200 wrote:
Sun Mar 04, 2018 4:54 pm
In our health plan/provider (Kaiser), they will not begin the procedure (administer sedation/anesthesia) unless the person driving/accompanying you home is physically present.
That is also my experience with my hospital. When I check in, I'm asked who is with me. No person - no procedure. A doctor goes and chats up that person who came with me before the procedure begins and gives them some information. Generally I am in excellent health and don't care if I am put under or not. What irritates me is that I cannot take a taxi home. I do not get the opportunity to act as an adult human being.

This may indeed be for the patient's benefit but I am cynical and think that 90% of this is for the hospital to avoid medical liability.



In my opinion, this is so you don't:

a) Forget where you live or tell the cab driver some oddball address
b) get into the cab, fall back asleep and get robbed or way, way, way worse.

We're docs, we're paid to worry about the worst possible thing. :wink:
Yes, maybe - I guess it is the system. I grew up in another country where there is only limited malpractice and I think that the doctors here make a tremendous fuss about everything. I like to be independent and so I hire my cleaning lady to take me. I am in much better health than she is and after the procedure, I can walk faster to my car than she can - without assistance. Its weird that she has to drive me home. Oh, well it is the system.
Last edited by Lynette on Mon Mar 12, 2018 9:14 am, edited 1 time in total.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by 4nursebee » Mon Mar 12, 2018 6:05 am

The best way to minimize the cost of this is to not get a colonopscopy.

I like what the following guy says and found the Worried Sick book of interest:

I don't care if I develop colon cancer in my 80s; something else is likely to kill me long before it can. I don't care if I develop colon cancer in my 70s either, for the same reason. Furthermore, screening me in my 40s is largely an exercise in futility; colon cancer is so very, very rare in 40-year-olds that the chances of a complication of colonoscopy far outweighs the chances of finding the rare cancer. It's in the 50s and 60s that finding and removing the rare colon cancer is likely to be meaningful to that person and worth the risks to all those who don't have colon cancer.

Hence, I had my one colonoscopy. In fact, I settled for a partial look (flexible sigmoidoscopy) because that was good enough risk assessment for me and the procedure is gentler and safer.

I am not alone in realizing the limitations of these tests and others such as mammography or even the annual physical examination. Many a researcher has been recruited to the task of improving screening tests. However, until we have much better screening tests, no person should be screened unaware of the limitations of the test.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Mon Mar 12, 2018 9:41 am

4nursebee wrote:
Mon Mar 12, 2018 6:05 am
The best way to minimize the cost of this is to not get a colonopscopy.
I like what the following guy says and found the Worried Sick book of interest:
I don't care if I develop colon cancer in my 80s; something else is likely to kill me long before it can. I don't care if I develop colon cancer in my 70s either, for the same reason. Furthermore, screening me in my 40s is largely an exercise in futility; colon cancer is so very, very rare in 40-year-olds that the chances of a complication of colonoscopy far outweighs the chances of finding the rare cancer. It's in the 50s and 60s that finding and removing the rare colon cancer is likely to be meaningful to that person and worth the risks to all those who don't have colon cancer.
Hence, I had my one colonoscopy. In fact, I settled for a partial look (flexible sigmoidoscopy) because that was good enough risk assessment for me and the procedure is gentler and safer.
I am not alone in realizing the limitations of these tests and others such as mammography or even the annual physical examination. Many a researcher has been recruited to the task of improving screening tests. However, until we have much better screening tests, no person should be screened unaware of the limitations of the test.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person.
My understanding (no medical credentials) is that Colon Cancer screening (several types including colonoscopy) is quite effective.

My mother had colon cancer in her early 30's and died before age 50 after it spread. I started with regular (old style) sigmoid screening 40 years ago, and get colonoscopies every 5 or so years.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by 4nursebee » Mon Mar 12, 2018 2:46 pm

Dr. Hadler in his book would make different arguments about the effectiveness of colonoscopies. I recall something like his data analysis suggests that 4 people are injured for every one life saved. I've met some of the injured and the problems were not minor. Hadler also discusses the economics of such things.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by boglegirl » Fri Mar 16, 2018 5:25 pm

woof755 wrote:
Sat Mar 03, 2018 10:49 pm
...

It's my understanding that finding a polyp no longer makes the procedure a fully covered screening test (it used to trigger it being a diagnostic exam). This never made sense to me, because polyps are what we were screening for in the first place. Why should insurers punish the patient for having what the test is designed to look for? I believe this is a thing of the past: https://blog.aarp.org/2013/02/25/free-c ... olyps-too/

You will likely receive a bill from the pathology department for your polyp analysis, though.
Hmmm....the linked article is from 3 years ago, and says that insurers should cover the screening colonoscopy at 100%, even if polyps are found & removed. But when I had my screening colonoscopy just a few months ago, the hospital made me sign papers agreeing that I would be responsible for some of the cost if they found polyps. :confused Luckily, everything was fine so I didn't have to test that.

For those of you mentioning the cost of the prep drugs being as high as $70 - those should have been covered at 100% also. At least mine were; when I went to the pharmacy the copay was $0.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by IowaFarmBoy » Fri Mar 16, 2018 5:38 pm

I've had seven colonoscopies if I am counting correctly. I had my first at 37 due to family history. In that one, they found three polyps, none of which were cancerous. Since then- I'm almost 60 now, they found one anal polyp on my next last procedure.

I went without sedation for the first 6. Generally no big deal, a little uncomfortable- kind of like cramping- but I got through them fine. It was pretty cool to see my insides in real time. And seeing the puff of smoke when they cauterized the polyps was also cool- I know I am wierd. Each time, they set me up with an IV in case something came up that they needed to put me out and I also had to have a driver. I don't think there was a cost difference.

The last time I went with the Versed and Fentanyl- in part because the anal polyp removal was a little painful and I thought I would give it a try. No problems and I got a really good nap after getting home but I pretty much lost the day.

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Re: Minimizing costs of a Colonoscopy

Post by joe8d » Fri Mar 16, 2018 7:56 pm

kenoryan wrote:
Mon Mar 05, 2018 11:41 pm
SlowMovingInvestor wrote:
Sat Mar 03, 2018 7:10 pm
If something is detected during a colonoscopy, and (say) a polyp has to be removed, does that convert the colonscopy from a screening to a diagnostic, and it then becomes chargeable ?

Yes.
Yes, That's what happened to me.
All the Best, | Joe

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sat Mar 17, 2018 9:44 am

4nursebee wrote:
Mon Mar 12, 2018 2:46 pm
Dr. Hadler in his book would make different arguments about the effectiveness of colonoscopies. I recall something like his data analysis suggests that 4 people are injured for every one life saved. I've met some of the injured and the problems were not minor. Hadler also discusses the economics of such things.
It is true, from what I read, that colonoscopies are more common in the US than in many similar coutries. There are also alternatives, such as flex sigs and fecal screening. The risks are not zero - but I have had many (about 8) over the decades with no problems. I will have another in the next 2-3 years. It is my (non-medical) belief and opinion that your risks are lower if you do a full and complete preparation.

What are the risks? This http://www.thepermanentejournal.org/iss ... ation.html seems to confirm my belief that the risks are low. The risk of perforation ranges from 0.027% to 0.088% for flexible sigmoidoscopy, from 0.016% to 0.2% for diagnostic colonoscopy, and up to 5% for therapeutic endoscopy.

I believe the seriousness of a "perforation" can vary a lot as well.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 17, 2018 1:52 pm

dm200 wrote:
Sun Mar 11, 2018 7:05 pm
woof755 wrote:
Sun Mar 11, 2018 3:22 pm
SlowMovingInvestor wrote:
Sun Mar 04, 2018 11:03 pm
One point worth mentioning is that some practices allow direct access colonoscopy -- i.e. you can have the screening colonoscopy without a previous Gastroenterologist visit. Even a referral from your regular primary doctor may not be needed if you meet the screening colonoscopy criteria.
This saves you the specialist's fee -- which could be around $200 or so for a HDHP plan.
[I am not sure if an office visit is scheduled after a screening colonoscopy if the results are normal, or if the office just calls you with the results.]
We do direct access at my current and my former job.
If patients request a visit, we'll see them.
There is no medicare billing code for a pre-procedure visit unless there are significant medical problems / medications to adjust, so there is no way for a GI to bill for a routine pre-procedure visit. I'm actually not sure if there is still a copay.
OK - here is the part I do not understand. From my decades long experience as a patient, there are multiple ways of addressing the risks of Colon Cancer. In such cases where it is not clear (to the patient) what are the pros and cons of the choices, how is that done without an office visit with the Gastroenterologist? Maybe the choice is as simple as flex sig vs colonoscopy - still an office visit discussion with the Gastroenterologist, right?
In the case of direct to procedure endoscopy, that discussion is undertaken by the primary care doctor who orders the test.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 17, 2018 1:53 pm

VictoriaF wrote:
Sun Mar 11, 2018 3:28 pm
woof755 wrote:
Sun Mar 11, 2018 3:18 pm
We're docs, we're paid to worry about the worst possible thing. :wink:
There is a fine line between caring and patronizing. For example, most medical practitioners would try to avoid getting cardiopulmonary resuscitation but perform it on others.

Victoria
This was intended to be self-deprecating, not patronizing.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sat Mar 17, 2018 1:57 pm

Epsilon Delta wrote:
Mon Mar 05, 2018 4:42 pm
Since I am FIRE I do a fair amount of driving for friends and family when they need help with medical and other appointments. I don't always know (and would not ask) the reason for every appointment.
I have driven at least three people to and from colonoscopies at least four separate occasions. On no occasion did I do more than wave at the receptionist. I was never briefed by anybody in either the medical office or by the patient. I never signed anything or went beyond the waiting room. In one case I left for about 20 minutes to visit Starbucks.
It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.
Interesting. Multiple experiences at several providers (both patient and driver) and in all cases - driver was 'vetted'

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 17, 2018 2:01 pm

4nursebee wrote:
Mon Mar 12, 2018 6:05 am
The best way to minimize the cost of this is to not get a colonopscopy.

I like what the following guy says and found the Worried Sick book of interest:

I don't care if I develop colon cancer in my 80s; something else is likely to kill me long before it can. I don't care if I develop colon cancer in my 70s either, for the same reason. Furthermore, screening me in my 40s is largely an exercise in futility; colon cancer is so very, very rare in 40-year-olds that the chances of a complication of colonoscopy far outweighs the chances of finding the rare cancer. It's in the 50s and 60s that finding and removing the rare colon cancer is likely to be meaningful to that person and worth the risks to all those who don't have colon cancer.

Hence, I had my one colonoscopy. In fact, I settled for a partial look (flexible sigmoidoscopy) because that was good enough risk assessment for me and the procedure is gentler and safer.

I am not alone in realizing the limitations of these tests and others such as mammography or even the annual physical examination. Many a researcher has been recruited to the task of improving screening tests. However, until we have much better screening tests, no person should be screened unaware of the limitations of the test.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of Worried Sick: A Prescription for Health in an Overtreated America and The Last Well Person.
I get what you are saying, and we don't offer colonoscopy to patients in their 40s unless they are at increased risk for developing cancer for some specific reason. We also don't recommend screening after age 75, unless the pt requests it. After 85, no further screening. And this isn't wet thumb in the air, these are guidelines from our College of Gastroenterology.

I wonder, though, if "I don't care if I get colon cancer when I'm 70" still means the same thing to someone when she turns 70 and is otherwise healthy.

We are very lucky to have non-invasive testing such as stool DNA tests and fecal immunochemical testing (from a stool sample) for patients who decline colonoscopy. Again, the best colon cancer screening test is the one that gets done. https://www.healio.com/gastroenterology ... -gets-done
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 17, 2018 2:03 pm

4nursebee wrote:
Mon Mar 12, 2018 2:46 pm
Dr. Hadler in his book would make different arguments about the effectiveness of colonoscopies. I recall something like his data analysis suggests that 4 people are injured for every one life saved. I've met some of the injured and the problems were not minor. Hadler also discusses the economics of such things.

Sorta like 4 people are injured by seatbelts or airbags for every life saved.
Interesting to downplay a life saved.
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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sat Mar 17, 2018 3:42 pm

I wonder, though, if "I don't care if I get colon cancer when I'm 70" still means the same thing to someone when she turns 70 and is otherwise healthy.
I am in my early 70's and hope to live another 25-35 years - so I DO care about getting colon cancer for many years.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by woof755 » Sat Mar 17, 2018 4:00 pm

dm200 wrote:
Sat Mar 17, 2018 3:42 pm
I wonder, though, if "I don't care if I get colon cancer when I'm 70" still means the same thing to someone when she turns 70 and is otherwise healthy.
I am in my early 70's and hope to live another 25-35 years - so I DO care about getting colon cancer for many years.
Right?!!!

When I was 10 I told my parents I was never gonna drink beer when I was old enough.
Now I'm old enough

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by Lynette » Sat Mar 17, 2018 4:10 pm

dm200 wrote:
Sat Mar 17, 2018 1:57 pm
Epsilon Delta wrote:
Mon Mar 05, 2018 4:42 pm
Since I am FIRE I do a fair amount of driving for friends and family when they need help with medical and other appointments. I don't always know (and would not ask) the reason for every appointment.
I have driven at least three people to and from colonoscopies at least four separate occasions. On no occasion did I do more than wave at the receptionist. I was never briefed by anybody in either the medical office or by the patient. I never signed anything or went beyond the waiting room. In one case I left for about 20 minutes to visit Starbucks.
It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.
Interesting. Multiple experiences at several providers (both patient and driver) and in all cases - driver was 'vetted'
Last time I went for a procedure, the doctor came and told me about the conversation he had had with my cleaning lady who drove me. She is an outspoken lady of Italian heritage and the doctor liked her very much. I have been for colonoscopies, bunion surgery and some eyelid surgery at different hospitals. The doctors are very fussy here about who accompanies you. I am also amused that it seems that I have to tell about ten different people my age, date of birth and why I am there! Then they put some kind of bracelet on my arm with this information as well. I guess they do not want to peform the wrong procedure on the wrong person!

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Re: Minimizing costs of a Colonoscopy

Post by SlowMovingInvestor » Sat Mar 17, 2018 5:48 pm

joe8d wrote:
Fri Mar 16, 2018 7:56 pm
kenoryan wrote:
Mon Mar 05, 2018 11:41 pm
SlowMovingInvestor wrote:
Sat Mar 03, 2018 7:10 pm
If something is detected during a colonoscopy, and (say) a polyp has to be removed, does that convert the colonscopy from a screening to a diagnostic, and it then becomes chargeable ?

Yes.
Yes, That's what happened to me.
So the entire colonoscopy is chargeable, or just the fee for polyp removal and pathology ?

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by likegarden » Sat Mar 17, 2018 7:02 pm

One poster wrote : 'I'm a gastroenterologist.
If we let a patient go home sedated unattended in a cab, a zillion awful things could happen. Let your mind go wild. We can not let this happen. If you don't understand this, it's probably because you don't understand the profound retrograde and anterograde amnesia that is associated with our sedatives. '
Thanks about writing this comment about amnesia, is important to me. My wife will drive me back after my colonoscopy next Wednesday. I will check if I will get that amnesia. I had polyps last time 4 years ago, hope that they will take all out should they find more. I know a 90 year old man, who has a colonoscopy every year,

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by LeeMKE » Sat Mar 17, 2018 11:05 pm

I've been the responsible adult and driver for 2 friends getting colonoscopies.

In one case, they were tired and a bit hungry, but fine.

In the other case, she was just a touch too happy and contented. So much so, that she said things she would have been quite embarrassed to know she said. If I'd asked her to give me a signed blank check, she would have happily done it. She remembered nothing later that day, but she thought she'd been lucid and "right as rain" immediately following the procedure.

And some folks hallucinate after anesthesia, which could be dangerous if you are driving.

But all of them think they are fine and ready to go.
The mightiest Oak is just a nut who stayed the course.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by dm200 » Sun Mar 18, 2018 6:50 am

While rare or uncommon, there is a risk of bowel perforation in a colonoscopy that may not be apparent to the patient until after returning home. If not treated very quickly, this could be fatal. You do not want to be alone and/or out of contact for a period after the procedure.

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by gasdoc » Sun Mar 18, 2018 9:19 am

Epsilon Delta wrote:
Mon Mar 05, 2018 4:42 pm
Since I am FIRE I do a fair amount of driving for friends and family when they need help with medical and other appointments. I don't always know (and would not ask) the reason for every appointment.

I have driven at least three people to and from colonoscopies at least four separate occasions. On no occasion did I do more than wave at the receptionist. I was never briefed by anybody in either the medical office or by the patient. I never signed anything or went beyond the waiting room. In one case I left for about 20 minutes to visit Starbucks.

It is possible that different anesthetic or such were used or that the standard of care is different in different places in the US. But clearly what people are reporting is not universal.

You are correct in that last assertion- what people are reporting is not universal. The only hard and fast rule is that patients should be discharged to a responsible adult if they have received sedation of any kind. Otherwise, there could be liability to the facility.

gas doc

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Re: [Minimizing costs of a medical procedure (Colonoscopy)]

Post by gasdoc » Sun Mar 18, 2018 9:37 am

A point of clarification of comments posted earlier in the thread- sometimes anesthesia providers are involved because a small percentage of the time there is a problem that requires immediate attention to prevent major catastrophic problems. Someone mentioned not receiving sedation for cataract surgery. In that case, anesthesia providers are there in case a patient becomes afraid, confused, etc and starts to move during the procedure on their eye- obviously that would be a problem, and we would immediately convert to general anesthesia and control of the situation. Also, there are neural reflexes that can cause cardia arrest. In the case of colonoscopy, it is less critical that patient movement be kept to a minimum, but it is difficult to predict how a given patient will react to a procedure. In any case, if you require the presence of an anesthesia provider, that person's time and training is what is being purchased, so it really doesn't matter how many drugs you receive. There have been many situations where I make a deal with the patient up front- we'll start with minimal sedation and titrate the meds as needed/requested by the patient. It would not be unreasonable to tell me- "hey, I am paying cash for this, please try to only use what is necessary." However, most of us do try to take cost into consideration even when insurance is covering the procedure.

gasdoc

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