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Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense.
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Hello,

I'm a male endurance athlete, 64 YO. At my most recent annual physical my Dr. mentioned that it was "that" time again, referring to a colonoscopy. However he mentioned that he was now suggesting to his patients a "new" procedure that did not require the usual and somewhat unpleasant preparation. I was not convinced, but was persuaded by him and agreed to go that route. The route in question was the Cologuard test.

Basically, you poop in a container and send it to a lab for evaluation. My test came back as positive. This positive result then necessitated a traditional colonoscopy in order to more definitively determine if there was an issue. When I met with the Dr. who would be doing the colonoscopy he told me that I would be responsible for the entire expense of the procedure due to the positive Cologuard test. He related that health insurances pay for diagnostic procedures of this type whether it be the Cologuard of the tradiotional colonoscopy (which by the way is considered to be the gold standard). But since I'd gotten the positive Cologuard, insurance no longer would cover the additional work!!!

Long story short, the colonoscopy came back normal with no issues. Thankfully! However I was now out about a total of $1,300....

I asked the Dr. if the fact that I was near the end of a marathon training cycle had any impact on the positive result. He wasn't sure until I mentioned that it is not unusual for distance athletes to have trace amounts of stool blood as a result of the training. Immediately he said yes, that that was the likely cause of the positive as the Cologuard test checks for abnormal DNA AND the presence of blood.

My family Dr. knows of my marathon training and I feel he should not have recommended the Cologuard in my case.

So, I'm posting this to: see if others have had the Cologuard, see if others had false positives, and to warn others in this situation to seriously reconsider using the Cologuard vs. colonoscopy.

Thanks
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [RONDAL] [ In reply to ]
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RONDAL wrote:
Every time i read a story about American Health Care i am reminded how absolutely broken that system is. - written by someone who is not american

x1000 ...

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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I can't quite tell if you're mad at your doctor, yourself, Cologuard, or your insurance company - perhaps all of the above.

A Google search will quickly show that while more convenient there are higher rates of false positives with Cologuard. Also, it's very clear that a positive (real or false) Cologuard result will necessitate a follow-up colonoscopy.

Glad to hear you're ok but it seems ther's plenty of "blame" to go around:

Doctor - for failing to take into account your full history
Yourself - for taking the "easy way" out and not fully researching the consequences and being better informed
Insurance company - for some really crappy (pun-intended) coverage
Cologuard - for the false positive and for generally selling this as the "easy way"
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [logella] [ In reply to ]
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I love to blame people for not taking responsibility, but in this instance, I don’t think you can blame the OP. You go to an MD for medical advice. You should not have to Google and form your own opinion (although I do).
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [logella] [ In reply to ]
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I'm mad at my doctor mostly. If you're a professional recommending tests, you should be more aware of possible consequences... I'm mad at myself for not educating myself. However, I was not aware of the issues going in, and would honestly have gone the traditional route if those potentialities were presented. It may seem like the easy way out, but being told by a trusted professional that this is "now the way to go" is persuading.

My Dr. is no longer a trusted professional :>)

I hope others may read about this situation and are able to make better decisions than I was.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I think the real takeaway here is that folks should know you are allowed "1" test for this to be paid by insurance. In a way it makes sense, so best to take the more accurate one first and foremost.

And that is not something your doctor would know, and if did, probably communicate it to you. So many companies with so many different rules, just not in this wheelhouse to know these things.

Had you known that one thing, all the other stuff would not have been a factor. Unless you doc is a marathon runner himself, why would he know more than you would about possible blood in stool? When it comes to athletes and their peculiar physiologies as compared to the general population, most docs won't know what those are. How many times do we go in and have to tell all the nurses and docs not to worry about our 30+ heart rates??

If you had a doc that was well versed in athletes and that was his speciality, then it would be bothersome you were not warned..
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [monty] [ In reply to ]
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Monty,

Good points!!

RE: the DR. knowing of blood in the stool, I learned of the blood stool issue by experience, and also visited this doctor immediately after it occurred to be sure there was nothing sever going on!!! He probably didn't remember....

In my running group, there are two physicians. They were aware of the issue, both the false negatives and the non-coverage for the necessitated second test. By the way, they no longer suggest this as the "way to go".
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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As a general rule I'm pretty skeptical of all "trusted" professionals. I try to do at least a little bit of research just to make sure there's nothing out there I should be aware of - "trust but verify."

Btw, have you double check with your insurance company what the doctor said about coverage? It might be worth looking into.

Out of curiosity I thought I'd see how my company's insurance plan would deal with something similar. As best I can tell both would be covered and there's nothing in there that would prevent it. The Cologuard would be covered under the "Preventative Care Services" portion of the plan 100% regardless of deductible. The colonoscopy would be covered at 80% (after deductible) under the Diagnostic Scopic Procedures section.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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In my running group, there are two physicians. They were aware of the issue, both the false negatives and the non-coverage for the necessitated second test.//

There you have it, maybe time to switch to one of your running buddies!! Doctors that do sport somewhat serious are the best for guys like you and me. Unlike a coach who may or may not have been an athlete, I think this is important for our health issues...I lost my 35 year sport special doc about 6 years ago, and have had a hell of a time replacing him. Have a young guy at the moment that I'm trying to train, but there are few doctors that know more that I do about athlete "special needs". (-;
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [RONDAL] [ In reply to ]
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RONDAL wrote:
Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american

I agree that the American Health system needs to be improved, however, let me be the first to say I am grateful I have access to it as I got to race this morning because I still have my health and fitness after having been diagnosed and treated for prostate cancer and melanoma. Because of our health system I was diagnosed early for both diseases and received "world class" treatment which resulted in a positive outcome. Yes, there is much to be improved, but when you get the big "C" diagnosis there is no other country that I rather be treated in that the good old capitalistic US of A!
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [TJ56] [ In reply to ]
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Yes, there is much to be improved, but when you get the big "C" diagnosis there is no other country that I rather be treated in that the good old capitalistic US of A!




Glad to hear you caught it early, and the docs were able to help you. And you are right, if you are insured(not one of the 30 million that are not) you are in pretty good shape here. But I think that 30 million is the rub that most people have, they would not have your outcome in this country where you enjoyed its benefits..
Last edited by: monty: Dec 8, 18 12:59
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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I blame mostly the insurance industry for finding loopholes to not pay.

Tests and non-funded procedures are newer for men, but women have been up against this for decades. Get a questionable or false-positive reading on a mammogram? Well, guess what?? Docs will advise for more frequent or repeat testing, all while not being covered by insurance. You can get the other boob tested on a regular schedule but the questionable reading on the other is now out of pocket.

The list goes on.

Sorry to hear about this. I'm in the town where Colorguard was created by Exact Sciences and have considered the test now that I'm in the AARP club.

Maybe I'll just drink the koolaid and pass out for a few hours.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [logella] [ In reply to ]
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Logella,

You are correct. At the point of the testing I had no medical expenses to go towards my deductible. Thus the full charge. I didn't go into all the details in my original post.

By the way, the Cologuard test was approximately $695 if out of pocket as compared to the $1300 for the colonoscopy.

I wonder what the insurance companies prefer.......
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [DarkSpeedWorks] [ In reply to ]
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DarkSpeedWorks wrote:
RONDAL wrote:
Every time i read a story about American Health Care i am reminded how absolutely broken that system is. - written by someone who is not american

x1000 ...

This ^ x another 1000

___________________________________________
http://en.wikipedia.org/...eoesophageal_fistula
http://en.wikipedia.org/wiki/Cerebral_palsy
Canadian Record Holder 35-39M & 40-44M - 200 m Butterfly (LCM)
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [realAB] [ In reply to ]
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I did the Cologuard test this summer. I felt bad for the UPS guy at the counter, "Here's my shit - in a box!" A little awkward but at least $700 better than drinking "the mix" and sitting on the toilet for 24 hours. The test came back fine, I have the GI tract of a 25 year old (but alas the prostate of a 66 year old).

I'm a bit torn with the whole medical profession: my dermatologist is kind of a dick but he finds all the bad stuff early and has great surgical skills so I put up with him.
My old GP pronounced me fit as a fiddle on my yearly exam 2 years ago - I had complete heart failure that afternoon and was "mostly dead" like the Dread Pirate Roberts. Off to the ER...
My Cardiologist is a saint, he and my NEW GP are totally awesome. I get to talk and they listen without interrupting.

All of this is now paid for by Medicare and my $300 a month AARP supplement plan. Other than my premium there are no out of pocket expenses for anything, anywhere, with any doctor in the country. The stress reduction is amazing, I wish every American could experience it and vote accordingly for Universal Healthcare.

"Aquabike is a swim then sleep session on aerobars ...."
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [RONDAL] [ In reply to ]
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Not just American, there are times when i go the dentist or opticians in Canada and i feel like an ATM. Fortunately it doesn't bother me to call them on this and it's normally rolled back.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [russ] [ In reply to ]
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So. I am an American and am wondering what the 'correct' next step would be (from an insurer POV) following the cologuard positive test. They won't pay for the confirmatory 'traditional' colonoscopy, as I inferred from the OP's description. So, what, then? Exploratory bowel surgery to look for the cologuard positive tissue? Or...what...exactly? I'm not being a dick, I'm trying to understand since I'm a nearly 58 y/o guy with a clean colonoscopy about 5 years ago and expecting to have the same option presented to me pretty soon...
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [giorgitd] [ In reply to ]
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Just to be clear, the second test is probably covered but not as a scheduled "well person" type test. If you've already met your deductible then they would pay at least a portion of your colonoscopy. Of course no matter what you pay, you really don't have much choice in the matter now that you have a positive Cologuard test. You pretty much have to keep going forward. The colonoscopy although more invasive is the gold standard for sorting out your lower GI. While they are looking around they can take samples for more exact tissue testing. Rectal cancer is not to be fucked with. Good luck, the odds are still in your favor for a clean bill of health.

"Aquabike is a swim then sleep session on aerobars ...."
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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Thank you for the heads-up!
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Fuller] [ In reply to ]
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We still don't have universal pharmacare or dental yet but we have it pretty good. My youngest child has pretty severe CP and we'd be living in a shack if we were American with all her care and equipment.


BTW

"have fun storming the castle"

___________________________________________
http://en.wikipedia.org/...eoesophageal_fistula
http://en.wikipedia.org/wiki/Cerebral_palsy
Canadian Record Holder 35-39M & 40-44M - 200 m Butterfly (LCM)
Last edited by: realAB: Dec 8, 18 20:18
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Fuller] [ In reply to ]
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Careful what you wish for with Universal Healthcare.
The concept is great but I don’t know of any country where the actual application of it works where the patients are happy and well cared for.

My current example of this is my father - a 70+ man in the UK that has been employed all his life and paid into the system.
For the past three months he has been suffering from a debilitating loss of strength in his arms, legs, and hands - this has resulted in his quality of life suffering and affecting his mobility. Well after multiple visits to the doc who initially blew it off as just aging has now agreed that an appointment is deemed necessary with a senior consultant (UK NHS terminology for a specialist). Guess how long he has to wait just to see this specialist for the initial appointment - 20 fucking weeks........ during which he is supposed to just deal with not being able to perform day to day normal functions.

Last year my mum had a lump in her neck that affected her ability to swallow - again took 12 weeks to see the senior consultant.

The US healthcare system may be screwed up but let’s not pretend that the universal healthcare model (NHS in the UK in my personal examples) should be held up as this wonderful alternative. I’ve lived within both systems and neither model seems sustainable/preferable as they actually function.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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Yes, had the test a year ago, but was negative. Thx for posting, because I will have to check insurance options when I decide to test again.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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The lesson I am taking from this (well... one of them) is that when it's my time for this (and it will be soon), I should probably insist on the full colonoscopy and say no to any suggestion of Cologuard. Yeah a hell of a lot less pleasant but at least I'll know the first time and won't have to pay extra.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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Lived in Germany for 5 years. Germans will complain loudly when not happy. Never heard a German complain once about quality of or access to healthcare. Not once.

US is a distant last in most healthcare metrics. Only thing it fares well in is interventionist medicine - where there's profit to be made. That's what you get when you apply capitalism to healthcare. You also get CEO of United healthcare making $66m income.
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