PSA: DON'T GET THE COLOGUARD TEST!!!

[Methos1979]

I really should have posted this topic in Open Mic last year but didn't. So, now onto my bold statement. Why should you NOT get the Cologuard test? Three reasons. First, they are notoriously inaccurate. False positives are super-common. False negatives probably less so but imagine getting a false negative when you really have colon cancer or more likely pre-cancerous polyps that aren't detected by Colorguard but would easily be detected AND removed by an actual colonoscopy. Second reason, the false positive means that you'll have to then go and have the colonoscopy anyway and in the meantime you'll be super-stressed that you might have colon cancer when in fact you likely don't. But here's the third and the most annoying reason to NOT get the Cologuard test: If you pop positive on a Cologuard test and then go get a colonoscopy YOU'LL HAVE TO PAY FOR THE COLONOSCOPY TEST FULLY OUT OF POCKET!

Yeah, that's right, the test that was free for almost any and all insurance's out there is now NOT covered. Why? Because a colonoscopy alone is considered a preventive medicine test covered 100% by almost all insurances. But a colonoscopy that is requested AFTER a positive Cologuard test is considered to be a 'diagnostic test' to confirm (or more likely deny) the test results of what is most likely a false positive from an inaccurate test! This happened to us. My wife put off having her colonoscopy for no good reason other than it weirded her out. I'd already had two done but she still resisted. I finally browbeat her into getting it done but she went the Cologuard route instead. The test came back positive so she then had to schedule the colonoscopy. On the day of the test they called us (thankfully) and told her that she would have to pay for the entire procedure out of pocket. Only $6,000.

Since then I have been on a mission to tell anyone and everyone I know to NOT use the Cologuard test. It makes me wonder if the Cologuard test was developed by the medical insurance industry as a way of them getting out of paying for a common but expensive procedure and passing it onto the policy holders.

[JackB1]

You are correct Scott. The Cologuard test is pretty useless IMO since it's so inaccurate and also like said, if it returns positive you will have to pay full price for a colonoscopy because now it's no longer preventative. Its so not worth it and a colonoscopy is such an easy procedure. You are asleep and didn't even know anything happened to you. The prep is the chore, but if you eat light leading up to it it won't be too bad. I was like your wife, a little freaked out by it. But felt stupid after it was over and it was no big deal. A few days of eating light and fasting the last day is nothing compared to the alternative.

[rokdog49]

I’m not sure paying for it after the Cologuard is true in all cases.

[JackB1]

Originally Posted by rokdog49

I’m not sure paying for it after the Cologuard is true in all cases.

With my insurance (Aetna) it sure is. Anything insurance companies can do to get out of paying they will do. When one tests dictates a procedure be done afterwards, it can no longer be classified as "routine preventative testing". It's now a requirement and that's why they don't cover it. Just get the colonoscopy! It's so worth it because they will remove any polyps they may find while doing it and that alone makes it worthwhile.

[Talk2Me]

Originally Posted by JackB1

With my insurance (Aetna) it sure is. Anything insurance companies can do to get out of paying they will do. When one tests dictates a procedure be done afterwards, it can no longer be classified as "routine preventative testing". It's now a requirement and that's why they don't cover it. Just get the colonoscopy! It's so worth it because they will remove any polyps they may find while doing it and that alone makes it worthwhile.

Aetna happens to be one of the stingiest insurance companies (which is saying a lot). Anything they can do to get out of paying they will (don't ask me how I know). Cologuard does warn you of that possibility though. From the site: "As of 2023, Medicare and commercial plans cover the out-of-pocket cost for a colonoscopy following a positive Cologuard result. Exceptions for coverage may apply; please confirm with your insurer. They are the best source of info on your plan and coverage."

I suppose it's a non issue if you're willing to pay Cologuard out of pocket and then your insurance company won't even know you did it. It's a hedge against a positive CG test but somewhat costly if it's negative I'd imagine.

[imwjl]

Originally Posted by rokdog49

I’m not sure paying for it after the Cologuard is true in all cases.

This is very much true. Our prior insurance was superior and also from a patient and physcian owned coop. They considered it reasonable screening and if risk seemed present you were referred to their associated specialty clinics. Some I know who are covered by various Medicare options say that is better.

Our current insurance that limits much more and an unfortunate situation many are in. You get one conventional test and the cheapskates won't pay for better prep for those of us who can't do the cheap stuff successfully.

As much as I get the imperfections with the test and how we get our healthcare, I would not suggest saying don't get a test.

[Methos1979]

It's less about the insurance than how the doctor 'codes' the request for the test. If they request it as a diagnostic test to confirm a previous test, you will pay. We have excellent Blue Cross, Blue Shield insurance. Maybe you can convince your doctor to not code it as diagnostic? Better yet, just get the real test done. Detecting and removing pre-cancerous polyps before they become full blown cancer seems to me to be way better than a false negative making you think you're okay until it's too late.

[lfoo6952]

Thanks for the heads up. I’m due for my 5 year colonoscopy this summer. I’ll be sure to remember NOT do the Cologuard test prior to the colonoscopy.

[TBman]

My doctor kept pushing that on me and I refused to do it. In my opinion a 5% - 10% margin of error renders the test useless.

[Glennwillow]

Wow, interesting stuff...

- Glenn

[eyesore]

Yeah ;I don't know about this Cologuard test. Like I said ; I've had 3 or 4 colonoscopies and they were all clean.My doctor got tired of telling me to get another at age 70 , so he suggested the cologuard.So I did it and it came back positive a few days ago.Not to be gross but ;I still GO as I ever have ! No issues, but I guess I'll be doing the scope soon.

[SCVJ]

Originally Posted by rokdog49

I’m not sure paying for it after the Cologuard is true in all cases.

It is true for medicare, at least it was about four/five years ago. Of course, my Dr. did not warn me about this issue and give me the choice of having the colonoscopy (a far superior diagnostic tool) or having the Cologuard test.

I took his suggestion to do the Cologuard and it came back positive, and then I found out about the full-price colonoscopy issue. I still haven't had a colonoscopy since then, which I certainly am past due for.

I'm guessing if you have a positive Cologuard you will have to wait a certain period of time before being eligible for a covered colonoscopy. I have no idea if this is true, or how long the wait may be.

For those who have never had a colonoscopy, do not wimp out on doing it. I've had three, and all were no problem, no discomfort, just the inconvenience of having to take a few hours to do it, and the prep is not pleasant. You are "twilight sedated", basically asleep, and feel nothing. At least that has been my experience.

[SCVJ]

Originally Posted by Talk2Me

I suppose it's a non issue if you're willing to pay Cologuard out of pocket and then your insurance company won't even know you did it. It's a hedge against a positive CG test but somewhat costly if it's negative I'd imagine.

I don't think this will work, I think the prescription of the cologuard is in your Dr's records. I also think Cologuard only reports results to your Dr, which also appears in your file, which is available to insurance co., which they review before approving the expensive colonoscopy.

Also, I think the C'guard test is a few hundred $$, not cheap IMO. An earlier post also mentioned as of 2023 things may be different for medicare insureds than they were for me five years ago.

It is amazing to me how complicated insurance issues are, and health care in general. The amount of time I spend on it is mind-boggling, and I had a lot of experience with it through my career, even though I was always very healthy and injury free until I reached the age of about 68. I really feel for the inexperienced, under-educated and poorly/wrongly advised.

[Tunesalot]

Cologuard requires a prescription to order. Costs about $500. Will see blood in stool which could be a false cancer positive from hemorrhoids, menstruation, diarrhea or ulcers. Then the follow up scope would not be covered as a screening but as an uncovered diagnostic. Hard to skirt the cologuard prescription and results delivery without a dupe doctor and cash. Kind of like your yearly exam and screenings are free, not subject to deductibles and copays, unless you have symptoms.

[Talk2Me]

Maybe this is the future and some potential hope given to the fearful:

https://www.npr.org/sections/health-...ly-study-finds