I could just scream!

[Catlady728]

So I was at my GP today for a follow up from having to go to him a week ago since the GI is impossible to get into short notice. Anyway he wanted to know if there had been any improvment, which of course there hasnt, and I actually feel some things (like nausea and pain shortly after eating) have gotten worse. So he poked around on me...decided to some more random blood test (West Nile and Lyme) and try to push the insruance to approve Pillcam. The GI had tried the Pillcam back in july but the denied it and said I had to do small bowl follow through.....well the GI one visit says it showed inflammation another visit he says it was clean....so I have no idea there.....but bascially in a nut shell, the GI has not tried to get the pillcam since July. Ok, sorry forgive the rambling, back to today, my GP is usually a very cautious on the mark about his diagonse and he has thought it was crohns or colitis or at the very least something going on in the small intestine since I started this whole song and dance in early June.....so he (the GP, not the GI who should have been doing it) was trying to push test.....he was not overly thrilled when I came in today with in increase in pain/nausea and having lost weight(I didnt lose that much, but it was also only a 5day period)


Ok now that Ive rambled and probably made no since at all.........has anyone else had problems with the insurance DENYING this pillcam test???? What did you do about it? Does anyone know how much this test costs out of pocket, w/o insurance coverage? Kinda makes MAD to have to even consider it, but there is a very really possibilty I may just have to bit the bullet and do it w/o insurance. I dont understand how they can except doctors to even diagonse stuff when the scopes from a colon or endo cant go all the way up/down?

 

[Catlady728]

oh i meant to say too that my GP called around 430 to let me know that he tried, he called the insurance, he was even willing to do an apply letter, but they wont approve it.

 

[Clash]

I was in a similar situation, in the last four years I have had an endoscopy, a colonoscopy w/ biopsies, treated for H. pylori, a HIDA scan(with low normal results) that resulted in removal of my gall bladder. They were never really able to find anything.

Then in Aug of 2011 my son started having issues and was dx'ed by colonoscopy in Jan of 2013 with Crohn's Disease located in the TI. Later that year I started having trouble again and went back to my GI(he was also the GI that diagnosed my son but after dx we moved my son to a Ped GI). The GI was convinced I had CD as well since my symptoms matched and my son was now dx'ed. He did another colonoscopy w/ biopsies, all was normal, endoscopy-normal. So he wanted to do a pill cam but insurance denied it. The said they required a SBFT first which came back normal, so they denied the pill cam again.

My GI said that we could keep appealing higher and higher up the chain but as I wasn't having symptoms and trying to get my son into remission I didn't pursue it but maybe you should. Also you might see if they would approve an MRE(magnetic resonance enterography) it is really good at visualizing the small bowel for wall thickening.

Good luck to you, I hope you get some answers soon!

 

[Catlady728]

yeah my GI didnt even offer to keep pushing it. After the SBFT, whether it was clean, or not (since he cant make his mind up) he said he was only pushing the pillcam because I was having D..which has now become C.......but I literally cannot go w/o taking a lax, but I HATE taking stuff like that because it makes ur bowels slower and even more depdent so I usually wait and hope currently on day 6 again with no movement. To me, that would single something amiss. Especially when I am what my coworkers consider a 'health nut' I eat gluten/dairy/soy free......I watch my corn and refined sugar. I dont smoke dont drink. So yeah its non of that you need to change diet/lifestyle crap.