What Would You Do?

[Jrg]

I have an endoscopy scheduled for this Wednesday but was just told that my insurance won't cover it. It's going to set us back probably more than $700 in the end. I'm so completely nervous that I'll spend the money only to get negative biopsy results, which would just frustrate me even more. I already tested positive on the deamiated (sp) gliadin iGa blood test, negative on the others. So I know there's a chance the biopsy could go either way. My question is, what would you do? Just assume you have celiacs, go gluten free & cancel the test, or fork over the money just to know for sure?

[kareng]

Have your GI contest that by giving the insurance company more info? It might delay it a couple of weeks but that is what most doctors offices do.

[Jrg]

Have your GI contest that by giving the insurance company more info? It might delay it a couple of weeks but that is what most doctors offices do.

They said it was because I hadn't reached my deductible for this year yet. I thought an endoscopy would fall under a different category but it doesn't so I'm not sure if contesting it will do any good.

[kareng]

They said it was because I hadn't reached my deductible for this year yet. I thought an endoscopy would fall under a different category but it doesn't so I'm not sure if contesting it will do any good.

That's not the same as your insurance won't pay for it. So an appeal wouldn't make any sense.

[Jrg]

That's not the same as your insurance won't pay for it. So an appeal wouldn't make any sense.

Well I didn't suggest an appeal. I said that my insurance wasn't going to cover it. I was originally told that it wouldn't be a problem & I would just have to pay a copay, so now that I found out I will have to cover the full amount I'm just wondering what people would do. I'm torn as to whether I should go through w/it or just take my blood results & vitamin/iron deficiencies & just assume to go gluten free to see what happens.

[Lock]

If it were me, I would go through with the endoscopy IF I trusted the GI doctor to be very thorough and to use the latest techniques to find any villous damage, if the damage exists. If the doctor is not up to speed with diagnosing celiac then a negative result will only confuse you more. But if he is very good, a negative result will assure you that your intestine is healthy. So my answer as to whether you should pay for this and go ahead with the procedure depends on the quality of the doctor.

[cyclinglady]

I'm self-employed and pay for our health insurance policy.  When you have a policy that has a deductible, you need to set aside money to cover that deductible.  Seven hundred dollars seems like a lot, but in perspective, it's not really.  Not when it involves your health.  

 

In my opinion, this is an "emergency".  The long term side effects of not treating celiac disease are far more costly.  Would you balk if you thought you had cancer?  If you were in a car accident and needed surgery?

 

That said, if you really can't afford the endoscopy, you can always go gluten free based on your blood test.    My hubby did just that.  Docs suggested that he give up gluten and he did.  He strictly adheres to the diet.  I got scoped only because I didn't have a tummy issues and had a hard time believing that both of us have gluten issues.  

 

Hope this helps!

[kareng]

Well I didn't suggest an appeal. I said that my insurance wasn't going to cover it. I was originally told that it wouldn't be a problem & I would just have to pay a copay, so now that I found out I will have to cover the full amount I'm just wondering what people would do. I'm torn as to whether I should go through w/it or just take my blood results & vitamin/iron deficiencies & just assume to go gluten free to see what happens.

 

 

I suggested it because I couldn't tell why they wouldn't cover it.  Thought it might help.

 

Myself - I would and did pay for my colonoscopy and endo with the deductible.  It cost a lot more than $700 but I had the colonoscopy portion and anesthesia, too.  I thought it was worth it to see the amount of damage and make sure nothing else was wrong.  We put money aside in a health reimbursement account but its too late for you for this year.  If you are young and haven't had anything medical to pay out before, its not something you would want to do.

 

If you decide to pay yourself. I would find out how much deductible you have to meet.  So you know how much your limit will be.  Also, will you have to pay the pathology company for looking at the biopsy?  Pay any additional for sedation?  Does the doctor bill separately from the center where you are getting the procedure done?  Just some additional costs to consider.   

[nvsmom]

It depends on you. Would a positive endoscopy help you stay gluten-free? What if the endoscopy is negative (there are a few around here with positive blood tests and negative scope - it's not uncommon), will that affect your dedication to the gluten-free diet?

 

I personally think a scope can be useful if you continue to have long term problems (which would be useful if you get re-scoped in the future for comparisson) or there is another un-idenified health issue in play that needs to be found.

 

I personally did not do the scope and just went gluten-free based on a couple of blood tests. I figured that if I continued to have problems, I could always get the scope done in the future to look for other problems.

 

You have to do what you feel comfortable with.   Aren't I helpful?  LOL Good luck with what ever you decide to do.

[Jrg]

Thank you everyone. I went ahead with the endoscopy today, so now I'll just wait for my biopsy results