Aetna refuses to fully cover colonoscopy

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By Tami Hoey By Tami Hoey

PHOENIX - For Dawn Disney and her husband, death is something they don't like to talk about.

"My brother passed away at the age of 43 from colon cancer," Disney said.  "And it spread to his liver from colon cancer.  And then my father passed away a few years afterward."

With her brother and father victims of colon cancer, Disney's doctors urged her for years to have a medical procedure called a colonoscopy, which detects cancer in the colon.

Disney's doctor say the procedure was preventative and even wrote letters recommending a colonoscopy.

But after getting the procedure done, Disney faced a new problem.  She says her insurance carrier Aetna, only covered a portion of the costs, saying the 43 year old is too young. However, if she was older the colonscopy would have been covered in full.

"But it's not until I'm 50 will they consider that a preventative screeing," Disney said.

Under most insurance plans, "preventative" tests are covered 100 percent. But unfortunately, Disney is getting stuck with a big part of the bill. "They're totalling about $1,500," Disney said.

Disney argues that this procedure was, in fact, "preventative" because of her family history and because her doctor believed it was preventative. Disney worries that, like her Dad, she may not live to be 50.

"He went through a lot," Disney said.  "Died very young. My dad, if he would have had a preventative screening, he would still be alive. It wasn't caught early enough."

Disney appealed to Aetna twice, but both times, they stood by their decision. So, 3 On Your Side got involved. but Aetna maintains they're not to blame.

In this statement, Aetna says: "Ms. Disney's current plan states that a colonoscopy will be covered under the  preventative services benefit for those at average risk and are 50 or older. We determined that Ms. Disney's colonoscopy and related services were medically necessary and paid the claims correctly under her plan's regular benefit levels."

Disney thinks it's ridiculous, and that Aetna's policy should be changed.

"It's sad to think that people aren't getting the health care they need because they can't afford it," Disney said. "And there's a screening that can prevent something that's gonna be thousands and thousands of dollars, or life. There's no price on life."