Are colonoscopies "medically necessary” after lung cancer? - 1252854

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sheril
Are colonoscopies "medically necessary” after lung cancer? - 1252854

I had the right lower lobe of my lung removed two years ago. The surgery went fine and I did not need chemo or radiation. About a week after surgery I was admitted for several days for “hyperbilirubinemia” with my numbers at least 10x as high as they should have been and I was a nasty fluorescent yellow. After many months, the numbers and my skin and eyes returned to normal. The only residual is my eyes are always dry and burning and I seem to lean towards being constipated, which was not an issue prior. I don’t see my oncologist anymore as he gave instructions to my primary care doctor on when and what to do for follow ups with blood work and CT scans. The oncologist had told me to be sure to have all cancer screening tests done. I am now 51 years old and my PCP scheduled my colonoscopy, which I had and it was fine. I just received a bill for $1500 for it. I “assumed” it would be covered as I am over 50 and have history of lung cancer. I talked to my PCP who gave me a Patient Centered Medical Home form he says my insurance company gave him and told me to call and talk to them. They tell me that my plan only covers colonoscopies that are “medically necessary”. My oncologist is only in the office twice a week and I have called the last two weeks to see if he feels it is or is not so that I can maybe have the claim resubmitted, as the diagnosis for colonoscopy was “screening”, as PCP felt it would be covered. Anyway, I would like to find out from an oncologist so I know whether it is or not and how to proceed to take care of this. Thanks very much. SheriL

Dr West
Reply To: Are colonoscopies "medically necessary” after lung

I don't think we can provide more insight than your oncologist. It sounds as if you were treated with curative intent for the lung cancer, that you have no evidence of lung cancer now, and that the colonoscopy was an appropriate screening test that is indicated for someone over 50. If you had advanced lung cancer and an anticipated survival far shorter than enough time to expect to develop a new unrelated cancer, it would make sense to not do screening. But if you have no evidence of lung cancer and were treated with curative intent years ago, the lung cancer shouldn't be an issue. And most insurers would cover a screening colonoscopy in a patient for whom a screening colonoscopy is the standard of care.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

sheril
Reply To: Are colonoscopies "medically necessary” after lung

Thank you for the reply. I see I didn't finish my statement regarding my oncologist. He is only in the office one day a week, so for two weeks I have called and talked to the nurse who takes a message and I don't hear back. I was really just wanting clarification from him on the comment he made to me to have cancer screenings done, if he thought it was medically neccessary to have the screenings (such as colonoscopy) because I am at higher risk for another cancer or just that it was "important" for me to have screening tests done as it would be for anybody over 50.