Screening Options when Insurance Companies Refuse to Precertify a Colonoscopy

Dr. Timothy Hoops
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
I have had constipation/with violent diarrhea for about 2 yrs, on and off constricted stools, bloating, it has steadily gotten worse over the last 6 months, no blood at this point. My physician referred me to a gastroenterologist to have a colonoscopy. My insurance company will not precertify a colonoscopy. They want me to have a sigmoid first, then maybe a colonoscopy.

Both parents, my grandmother, and many aunts and uncles have died of other cancers. I know there is something wrong, maybe not cancer, but something. What should I do?

Dr. Timothy Hoops, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

I am sorry that you are having such a hard time with your insurance company. If you are older than 50, you should be able to argue for a colonoscopy as a screening procedure. Even if you are over 40, you might be able to push that argument. You have had a change in bowel habits, and that may warrant some type of procedure. If you are young, a flexible sigmoidoscopy may be sufficient. As you stated, you may have to show that it is negative before a colonoscopy is approved.

You also mentioned a family history of cancer, but not of the colon. There are not many sporadic cancers that are associated with colon cancer, so I wouldn't be too concerned about that unless it appears that you might have one of the inherited cancer syndromes. I would recommend that you go back to your internist or gastroenterologist and ask what they feel the best test would be. If it is a colonoscopy, I would be persistent with your insurance company. The "squeaky wheel" often does get the grease but you must persist. Unfortunately, health care decisions are not always left to the patient and the physician.