topic Re: Colonoscopy with a pacemaker in Wellness

Colonoscopy with a pacemaker

Trailrun23 — Wed, 08 Feb 2023 17:23:36 GMT

DH is supposed to have this three year colonoscopy after getting a letter saying he was overdue fo it...at his last one they found two benign polyps. He called to schedule the procedure and when they found out he had a pacemaker out in last summer and was also on Eloquis, he could not have the colonoscopy at the same outpatient clinic he had his others. He wa told he had to be admitted to the hospital and it would be done as an inpatient and he would have to stay overnight. Medicare says they only cover colonoscopies if they are outpatient, not done in the hospital as inpatient. Aetna also says the same. Anyone had experience with this scenario?

Re: Colonoscopy with a pacemaker

Shelbelle — Wed, 08 Feb 2023 17:30:53 GMT

Just curious as to why has to return in 3 years, I have had 2 screenings both found 2 benign polyps and I was told to return in 10 years both times. as long as the polyps are hyperplastic which is totally benign and they would never turn cancerous, only adenomas do that. I assume his were labeled as adenomas.

I know those on blood thinners have to stop taking it at least a few days prior and have the outpatient screening, but dont know about the other issue.

Re: Colonoscopy with a pacemaker

Trinity11 — Wed, 08 Feb 2023 17:41:44 GMT

@Trailrun23 wrote:
DH is supposed to have this three year colonoscopy after getting a letter saying he was overdue fo it...at his last one they found two benign polyps. He called to schedule the procedure and when they found out he had a pacemaker out in last summer and was also on Eloquis, he could not have the colonoscopy at the same outpatient clinic he had his others. He wa told he had to be admitted to the hospital and it would be done as an inpatient and he would have to stay overnight. Medicare says they only cover colonoscopies if they are outpatient, not done in the hospital as inpatient. Aetna also says the same. Anyone had experience with this scenario?

Yes. Aetna covered it. If your physician says you would be at risk during the prep, or after, it will be approved if your insurance company gives an authorization. As a Type 1 diabetic with heart disease, on a myriad of meds, I had no problem getting the authorization for an in hospital procedure.

Good luck @Trailrun23 .💐

Re: Colonoscopy with a pacemaker

Kachina624 — Wed, 08 Feb 2023 17:53:31 GMT

@Shelbelle wrote:
Just curious as to why has to return in 3 years, I have had 2 screenings both found 2 benign polyps and I was told to return in 10 years both times. as long as the polyps are hyperplastic which is totally benign and they would never turn cancerous, only adenomas do that. I assume his were labeled as adenomas.
I know those on blood thinners have to stop taking it at least a few days prior and have the outpatient screening, but dont know about the other issue.

@Shelbelle I've had benign polyps with every colonoscopy and have always been told to return in 3 years. You could be dead in 10 years.

@Trailrun23 If your insurance company refuses to cover the inpatient hospitalization, you're probably going to have to get documentation from the doctor and appeal the decision. Get info on their appeal procedure. They are supposed to cover what Medicare doesnt.

Re: Colonoscopy with a pacemaker

Spacrazy — Wed, 08 Feb 2023 18:03:01 GMT

@Trailrun23 Just let your doctors' offices handle it - they will. Of course I always reiterate that any service/procedure is authorized before having it done. Good luck to you and yours.

Re: Colonoscopy with a pacemaker

lgfan — Wed, 08 Feb 2023 18:11:41 GMT

@Spacrazy "@Trailrun23 Just let your doctors' offices handle it - they will. Of course I always reiterate that any service/procedure is authorized before having it done. Good luck to you and yours."

I agree with you. A doctor's office personnel knows which codes to use for medical insurance to cover a procedure. A doctor will not do any procedure until he/she knows that they will get paid by the insurance. In that way they are like the world's oldest profession. Pay up first before any service is rendered.

Re: Colonoscopy with a pacemaker

msgb — Wed, 08 Feb 2023 18:36:10 GMT

My mother had a colonoscopy with a pacemaker. It was an out patient procedure done in the hospital. My mother also had had two aortic aneurysm dissections by that time.
My mother's procedure was done by a gastro doctor who did colonoscopies all the time.

The blood thinner could be the reason for the extra concern. There are blood thinning techniques that can be done for a few days prior to the procedure that could allow the colonoscopy to take place.

My mother passed last year and had worn a pacemaker for 10 yrs. (Reason for passing had nothing to do with the pacemaker). The colonoscopy was in 2017 and there was nothing stating that she had to remain in the hospital overnight.

Re: Colonoscopy with a pacemaker

Shelbelle — Wed, 08 Feb 2023 18:47:58 GMT

No chance of being dead in 10 years, my gastro doc explained to me that there are 2 types of benign polyps, Hyperplastic ones that will never turn cancerous, these are more like skin tags, but they are removed during the procedure, so for these a 5 to 10 year span is fine. the others are called Adenomas which are benign at the time of the screening but if not removed may very well turn cancerous. It depends on what the lab says once they are removed. People with Adeniomas are usually asked to return in 3 years. Mine were Hyperplastic. .

Re: Colonoscopy with a pacemaker

CelticCrafter — Wed, 08 Feb 2023 19:49:05 GMT

@Kachina624 wrote:

@Shelbelle wrote:
Just curious as to why has to return in 3 years, I have had 2 screenings both found 2 benign polyps and I was told to return in 10 years both times. as long as the polyps are hyperplastic which is totally benign and they would never turn cancerous, only adenomas do that. I assume his were labeled as adenomas.
I know those on blood thinners have to stop taking it at least a few days prior and have the outpatient screening, but dont know about the other issue.
@Shelbelle I've had benign polyps with every colonoscopy and have always been told to return in 3 years. You could be dead in 10 years.

@Trailrun23 If your insurance company refuses to cover the inpatient hospitalization, you're probably going to have to get documentation from the doctor and appeal the decision. Get info on their appeal procedure. They are supposed to cover what Medicare doesnt.

If Aetna is a supplement plan, they do not cover what Medicare doesn't cover. If a test or procedure isn't covered by original Medicare the supplement does not cover it.

What the supplement does cover is the Part B deductible (depending what plan it is) the co-insurance and the co-pay if you took a plan with one.

Re: Colonoscopy with a pacemaker

chrystaltree — Wed, 08 Feb 2023 20:58:10 GMT

That's my problem too! I don't have a pacemaker. I have Afib and I'm on Eliquis. After a dozen attempts to schedule my colonoscopy, I'm being told they can't do it outpatient with observation. It must be done in a hospital setting but my insurer will only approve outpatient. I don't know if they are appealing this because endoscopy nurse didn't answer her phone. All I can do is email my pcp and ask her if she can help.

Re: Colonoscopy with a pacemaker

Shelbelle — Wed, 08 Feb 2023 22:24:54 GMT

@chrystaltree wrote:
That's my problem too! I don't have a pacemaker. I have Afib and I'm on Eliquis. After a dozen attempts to schedule my colonoscopy, I'm being told they can't do it outpatient with observation. It must be done in a hospital setting but my insurer will only approve outpatient. I don't know if they are appealing this because endoscopy nurse didn't answer her phone. All I can do is email my pcp and ask her if she can help.

My friend has A Fib and is on a blood thinner, she had a colonoscopy not too long ago, just had to stop her blood thinner a few days ahead, was done in a Surgi Ctr and sent right home.

Re: Colonoscopy with a pacemaker

hckynutjohn — Sun, 26 Feb 2023 17:49:14 GMT

@Trailrun23 wrote:
DH is supposed to have this three year colonoscopy after getting a letter saying he was overdue fo it...at his last one they found two benign polyps. He called to schedule the procedure and when they found out he had a pacemaker out in last summer and was also on Eloquis, he could not have the colonoscopy at the same outpatient clinic he had his others. He wa told he had to be admitted to the hospital and it would be done as an inpatient and he would have to stay overnight. Medicare says they only cover colonoscopies if they are outpatient, not done in the hospital as inpatient. Aetna also says the same. Anyone had experience with this scenario?

@Trailrun23

Most of my 16 Colonoscopies were done because of my Colon bleeding, as were 4 of my 5 Double Balloon Enteroscopies.

The Pacemaker is not a problem, but being on a blood thinner? Any type of invasive procedure I have had, which is many!

When I was on Plavix/Coumadin/Warfarin, or Lovenox, I had to be off all of them for a minimum 7 days prior to invasive procedure. That would include my many Endoscopies and Colonoscopies. Even off for 10 days when I had my Greenfield Vena Cava Filter installed.

hckynut 🇺🇸

Re: Colonoscopy with a pacemaker

chrystaltree — Thu, 09 Feb 2023 05:01:52 GMT

@Shelbelle wrote:

@chrystaltree wrote:

That's my problem too! I don't have a pacemaker. I have Afib and I'm on Eliquis. After a dozen attempts to schedule my colonoscopy, I'm being told they can't do it outpatient with observation. It must be done in a hospital setting but my insurer will only approve outpatient. I don't know if they are appealing this because endoscopy nurse didn't answer her phone. All I can do is email my pcp and ask her if she can help.

My friend has A Fib and is on a blood thinner, she had a colonoscopy not too long ago, just had to stop her blood thinner a few days ahead, was done in a Surgi Ctr and sent right home.

That's exactly what my Cardiologist said when I saw him. He even put a separate note in my medical record clearing me for the colonoscopy and documenting that I could go off the blood thinner for 2 days prior. I thought I was all set. "Hospital setting" does not mean I would have to spend a night in a hospital. It means endoscopy department in my group practice wants it done at the hospital. I'd still go home after the procedure. The problem for the insurer is that a colonoscpy in the hospital costs a lot more $$$$$ than if it was done in the endoscopy suite. This is what I did for a living before my recent retire. I get what's going on and I know how to get through it. That's why I want to speak with the Endoscopy nurse.

Re: Colonoscopy with a pacemaker

ScrapHappy — Thu, 09 Feb 2023 12:21:14 GMT

@Trailrun23 wrote:
DH is supposed to have this three year colonoscopy after getting a letter saying he was overdue fo it...at his last one they found two benign polyps. He called to schedule the procedure and when they found out he had a pacemaker out in last summer and was also on Eloquis, he could not have the colonoscopy at the same outpatient clinic he had his others. He wa told he had to be admitted to the hospital and it would be done as an inpatient and he would have to stay overnight. Medicare says they only cover colonoscopies if they are outpatient, not done in the hospital as inpatient. Aetna also says the same. Anyone had experience with this scenario?

My guess would be not so much about the pacemaker as it is with the Eliquis. Probably would want to watch him more to make sure there isn't any bleeding, especially since there is a history of polyps. I worked at an outpatient Endoscopy Center. Your husband would be the type of patient that one of the doctors would do the procedure at a hospital other than their own Endo Center.

Re: Colonoscopy with a pacemaker

hckynutjohn — Thu, 09 Feb 2023 19:14:58 GMT

@ScrapHappy wrote:
@Trailrun23 wrote:
DH is supposed to have this three year colonoscopy after getting a letter saying he was overdue fo it...at his last one they found two benign polyps. He called to schedule the procedure and when they found out he had a pacemaker out in last summer and was also on Eloquis, he could not have the colonoscopy at the same outpatient clinic he had his others. He wa told he had to be admitted to the hospital and it would be done as an inpatient and he would have to stay overnight. Medicare says they only cover colonoscopies if they are outpatient, not done in the hospital as inpatient. Aetna also says the same. Anyone had experience with this scenario?
My guess would be not so much about the pacemaker as it is with the Eliquis. Probably would want to watch him more to make sure there isn't any bleeding, especially since there is a history of polyps. I worked at an outpatient Endoscopy Center. Your husband would be the type of patient that one of the doctors would do the procedure at a hospital other than their own Endo Center.

@ScrapHappy

Totally agree. All of my 16 Colonoscopies/5 Double Balloon Enteroscopies, and 25+ Endoscopies, were done in the hospital. Most were done as an In-patient, primarily because I was in the hospital, with my Gastro Doctors, trying to find the source of my Colon bleeding.

I obviously was not on any blood thinners during any of my long hospital stays. My longest in 2008, was over 4 weeks. I had been on Coumadin/Warfarin since my 1st bout with Pulmonary Embolism(PE) in 2002, the 2nd episode in 2003.

I know with Coumadin/Warfarin your blood clotting can be checked using your INR/ProTime readings, same with Lovenox. I have heard nobody in the medical field, explain to me what data they use to know ones clotting factors, while on Eliquis/Pradaxa or Xarelto.
@ScrapHappy , if you know would you please enlighten me? Thank you.

For me those were/are life saving readings. Not only did I suffer from 2 different episodes of PE, I also had internal bleeding. Were I not at a building connected to the hospital, doing my Cardiac Rehab? All my internal organs bleeding out would have killed me.

If you are familiar with INR/ProTime numbers, you know exactly what I am saying. Your numbers are too low? You are susceptible for clotting. Same numbers too high? You are susceptible to your organs bleeding out. I unfortunately, have experienced both.

"A couple days off of blood thinners"? With Plavix, my Hematologist wouldn't clear me for any invasive procedure for 14 days. For Coumadin/Warfarin, depending on the procedure, 7-10 days.

That is the purpose of injecting Lovenox, which I also did, for 90 days(180 self injected shots). While Coumadin/Warfarin stay in your blood stream for 72 hours, Lovenox stays for only 12 hours. That is why Lovenox is often used after a major surgery while in the hospital.

Not enough patients have a clear understanding about the benefits and/or dangers while on any type of blood thinner. A lot of that info comes along in the 5 pages that come with their prescriptions. How many do you think actually read all those pages?

Now! What about a patient with a Watchman installed? As far as I know there are no contraindications to keep one from having a Colonoscopy.

hckynut 🇺🇸

Re: Colonoscopy with a pacemaker

Trailrun23 — Sat, 18 Feb 2023 04:18:40 GMT

He was told he needed the repeat colonoscopy due to his age of 76. If this one turns out to be okay with no polyps, then it is five years. Thanks everyone for the helpful feedback. They are now putting it off even longer, so it must not be as urgent as they say....he has had no symptoms of anything that would cause concern.

Re: Colonoscopy with a pacemaker

Trailrun23 — Sat, 18 Feb 2023 04:22:38 GMT

There is so much turnover in both of his dr offices it has been ridiculous to get things done. Zero confidence in the front office people, but he has total confidence in his drs.

Re: Colonoscopy with a pacemaker

chrystaltree — Sat, 18 Feb 2023 14:07:22 GMT

Update. I've been with the same large group practice for my entire adult life

Partly because I receive all my care under one roof. They have their own outpatient surgi center for less invasive procedures. So this problem with scheduling a colonoscopy surprised me and my doctor. Anyway. I ended up telling my doctor to refer me to one of the larger Boston hospitals. She did the referral and the next day, I received a call from their scheduler. I'm scheduled for 6/28.

Re: Colonoscopy with a pacemaker

lgfan — Tue, 21 Feb 2023 16:50:39 GMT

Chrystaltree is there a reason why it was scheduled for such a late date? When I scheduled my colonoscopy the doctor's office had an appointment available in a couple of weeks.

Re: Colonoscopy with a pacemaker

chrystaltree — Sat, 18 Feb 2023 19:30:07 GMT

@lgfan wrote:
Chrystaltree is there a reason why it was scheduled for such a late date? When I scheduled my colonoscopy the doctor's office had an appointment available in a couple of weeks.

It wasn't late. It was the earliest opening they had for a routine colonoscopy. I'm in no hurry. I just wanted it scheduled so I can plan my summer around that week. If I had symptoms or needed a diagnostic colonoscopy, they'd have scheduled me much sooner.