Follow
Share

I had Stage 4 Colon Cancer back in 2010. As a result, I am considered high risk. I went for a screening 3 years ago and no polyps were discovered.I went last month (here 3 years later) and it was discovered I have 5 polyps. Doctor says I have to return next year. From what I understand under Medicare I can only go every 2 years as a high risk. I have AARP United Healthcare Medicare Advantage HMO and something tells me that I won't be covered next year either from Medicare or United. Anyone have any thoughts or experience wth this situation? Thank You.

This question has been closed for answers. Ask a New Question.
Discuss with your doctors. They will have to work on coding and pre-approval of payment.

I am a bit confused by your saying that 10 years ago you were diagnosed with stage IV colon cancer, as that stage is not considered "curable". It IS treatable. And in those cases not only are more frequent exams allowed, but CT and PET and MRI scans are allowed and approved.

So this is something you will need to work with your medical team on getting pre-approved.
Helpful Answer (3)
Report

Those of us with stage 4 cancer always have stage 4 cancer as we're never considered "cured". What I do know as a stage 4 cancer survivor with Medicare is that my oncologist sends me for PET scans, and any other tests he deems necessary, every 3 to 6 months and they're ALL covered 100%, less co pays, under Medicare and my supplement. And if they weren't, for WHATEVER reason, I'd pay for them myself.
Helpful Answer (4)
Report
Fawnby Jul 2, 2025
Great information. I always wonder why it is that when a doctor informs a patient that their insurance won't pay for a procedure, they don't add that the patient can pay for it if they are able to. I know someone who had sleep apnea as proven in sleep studies, but Medicare wouldn't pay for the CPAP. I don't know why. Patient was not given the option to pay privately and suffered a stroke in his sleep a few years later. Of course, patient could have asked to pay for the machine but probably wasn't savvy enough about the situation to think of it. Now he's on CPAP for the rest of his life AND impaired on one side.
(2)
Report
Just because the doctor recommends it doesn't mean you have to do it next year. Don't think you want to pay for a colonoscopy out of pocket. High risk means its in the family or you have had cancer before. You now have polys. You need to check with your MA. They must follow parts A and B. With polyps present they may OK one year. If not, you tell the doctor that you can't get another one for 2 years.

Really, doctors are clueless when it comes to health insurance and what is covered. Thats why they hire people who know.
Helpful Answer (1)
Report

Unfortunately, Medicare Advantage plans can be pretty stingy. If you have a Medicare Advantage plan, you *no longer* have Medicare, The plan, not Medicare, determines what care you will or not receive. The person ordering the exam and/or testing probably has to obtain prior authorization for whatever diagnostic procedures are necessary. File an appeal if they first turn it down. If the appeal fails, you'll probably have to pay for it yourself. I'm sorry to be so negative, but again, that's one way that Medicare Advantage plans make their enormous profits, by delaying and/or denying care. But fortunately, many appeals end up in the Medicare Advantage plan approving what they initially denied.
Helpful Answer (1)
Report
JoAnn29 Jul 4, 2025
Medicare Advantages are contracted by Medicare to provide parts A&B. My daughter ran an Woundcare unit and was fighting MAs all the time because they must provide Medicare A&B. They tried to tell my daughter otherwise butbin the end they paid.
(1)
Report
AlvaDeer. Correction on my part. I had Stage 3 Colon Cancer, not Stage 4. My error. Sorry to have confused you. Your comments are well received.
Helpful Answer (1)
Report

I have worked in a GI office for 25 years and I can tell you there are billing modifiers to use for cases like this. If you PERSONALLY had colon cancer at any time you are considered high risk and we ALWAYS scope these patients with no issues from the advantage plans. Talk to someone in the billing department of the office you go to and verify that they will use the correct codes and modifiers.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter