Colonoscopy with a pacemaker

Trailrun23 · ‎05-31-2022

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?

Shelbelle · ‎03-09-2010

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.

Trinity11 · ‎11-16-2014

@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 .💐

Kachina624 · ‎03-10-2010

@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.

New Mexico☀️Land Of Enchantment

Spacrazy · ‎12-14-2018

@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.

lgfan · ‎10-19-2012

@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.

msgb · ‎08-30-2010

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.

Shelbelle · ‎03-09-2010

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. .

CelticCrafter · ‎03-09-2010

@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.

chrystaltree · ‎05-10-2010

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.