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A friend's relative received a positive test result on a recent Cologuard test. Should she be worried about colon cancer? I read that there is 13% chance of a false positive result. Of course we won't know anything until a colonoscopy is done. Anyone have any experience with this? The relative does not have hemorrhoids and didn't eat any of the foods that can trigger a false positive.

-lt

I'm not a fan of the test. There are too many steps and many chances for error. As Tushnurse the gold standard for screening is a colonoscopy. PERIOD.

The chance of doing the test wrong and a false positive is 1 option. The chance of a positive test and fixing it in a scope is high. Colon cancer by the time you have symptoms it is too late.

Just get scoped!

But if your friend isn't having symptoms like blood in stool, fily history, belly pain etc them the most likely problem is a polyp and having then removed via a colonoscopy is why colonoscopy is so darn important.

What tushnurse said.

Screening colonoscopies are [supposed to be] free in the US under the ACA. The problem with choosing Cologuard instead is that if it comes back positive, the follow-up colonoscopy is now a diagnostic procedure rather than a screening procedure, and you'll likely have to pay for it unless you've met your deductible for the year.

I don't know if it was here or somewhere else that I learned this: Many people don't go back for the diagnostic colonoscopy because they can't afford it. I can't imagine just walking around knowing I had a positive result and wondering if my colon is trying to kill me, but also not being able to afford it. That's so stressful.

tl;dr: Always choose the colonoscopy in the first place.

Medicare made an exception to their policy when somebody has a positive Cologuard result. The follow-on screening colonoscopy with the scope is still covered under the preventive service benefit. It should be reported as a regular screening colonoscopy. I have to read the Physician Final Rule, and can get you the reference if you need it. (Part of my job is to read the Medicare Physician Fee Schedule final rule.)

The rationale for covering it as a follow-on screening is to ensure that people were following up with the positive Cologuard test and remove the cost issue.

Screening colonoscopies are [supposed to be] free in the US under the ACA.

What if the reason you're getting the colonoscopy is because you've had polyps and it's recommended you get screened every three years?

I ask because my daughter in CA just had to pay over $1000 for her colonoscopy a couple of months ago. It was done because she had a polyp on her first colonoscopy, which she had in her early 30s when it was thought I had a genetic mutation that put me at a very high risk for colon cancer. My classification has since been downgraded, but my initial diagnosis flagged everyone. She did test negative for the genetic mutation.

Thanks for the responses! The relative tried to schedule the colonoscopy yesterday, but there was no one answering at the doc office. They did find out that the insurance company was the one who ordered the Cologuard test. Not any of her doctors.

There are no symptoms, so if there is something, it's early stages.

Medicare made an exception to their policy when somebody has a positive Cologuard result. The follow-on screening colonoscopy with the scope is still covered under the preventive service benefit.

Good to know!!

Number 4 it is not a clear answer to this. It honestly depends on her insurance plan and deductible rules and the physician had to code it as diagnostic not screening due to prior polyp.
Now if this one is clean the subsequent one can be scheduled as screening.

Medicare made an exception to their policy when somebody has a positive Cologuard result.

I wish that was the case for other insurance, too. My friend just had to pay over $1k as a copay after getting a positive Cologuard result. He's on an Aetna PPO.

What if the reason you're getting the colonoscopy is because you've had polyps and it's recommended you get screened every three years?

I juuuust read an NPR article (to find it, search for "Cancer screenings like colonoscopies are supposed to be free. Hers cost $2,185") that some insurance companies are charging for colonoscopies for those at an elevated risk because they're not consider "screening" procedures. It's complete BS, IMO.

@SacredSoul - thanks for the article suggestion!! How infuriatingly frustrating. I'm happy the woman interviewed for the article got her procedure code changed. I don't know if my daughter could navigate that. I am going to send her a link to the article and leave it to her to decide whether she wants to pursue it or not. I can't remember if they found anything this last time.

Some of this also boils down to my genetic mutation I think, and whatever she's passing along to her GI doc. After my appt. with my medical oncologist last week, she suggested I meet with a genetic counselor/geneticist again to determine exactly what classification I fall under at this point. I've never had a polyp, and no one in my family has had colon cancer. I had been under the annual colonoscopy plan, but my GI in CA told me that with the reclassification, I could go every three years. I need to also find a new GI doc out here.

I would hate for my daughter to be charged for colonoscopies based on the questionability of my genetic mutation. I mean, she just passed on what my doctors told me, to her own doctor. Ultimately, she did not test positive for the same gene I did. But during that first colonoscopy, she had a polyp. It might be an uphill battle for her to fight the charges.

Edited to add: I can understand my older daughter getting charged since she does have a dx of celiac.

[This message edited by number4 at 10:31 PM, Tuesday, August 20th]

Hey Number4, thanks for explaining how considering family history changes the track people get put on (in some situations).

My experience was never like that, until I had the weird symptoms that led to a "Diagnostic" screening, even though it had been 5 years since my last screen, but supposedly I was on the 10 year schedule, having had my first one at age 51 and then 61, both clear.

My doctors were talking about genetics a LOT. I guess it is for the best to just swallow the darn prep and do the scope!

Keep forgetting to post an update.

Colonoscopy was done last week. All clear.
She goes back in 7 years. No more Cologuard tests!

Glad the report is all clear.

Yay!