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My surgeon saw me one month after takedown and I plan to see him at 4 months and then at some point later in the year to have a pouchoscopy.

 

I did have a small contained leak before takedown so he wants to keep an eye on me although so far things have gone ok (touch wood it continues)

 

Here in the UK I asked for authorization for the 4 month follow up and they said sorry we don't cover maintenance.

 

however after an email from my surgeon explaining that ongoing assessment of the pouch is needed for at least a year with a pouchoscopy at around a year the insurance company eased up abit and approved my next consultation and said they will need an update from the surgeon regarding the next one and pouchoscopy.

 

I just wondered what other peoples experiences of insurance and post takedown check ups/consultations are. I appreciate insurance companies operate differently here in the UK to in the US

 

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For pouches with pouchitis/inflammation and/or a dysplasia/cancer history in the colon, annual scopes are indicated and typically are covered by insurance carriers in the USA.  I have had annual scopes for the last 20 plus years.  The reason for this is that they leave rectal cuff tissue inside you and so long as there is inflammation, it needs to be biopsied as the threat of rectal cuff cancer exists, especially if you had dysplasia in your colon pre-colectomy.  If you had dysplasia in the colon, from what I have been told, an annual scope schedule is suggested to monitor and watch that rectal cuff to see if anything develops.

 

For pouches that show no inflammation at the one year mark posttakedown, and where no history of dysplasia or cancer is present, you can be put on a scope schedule of anywhere from every 2-3 years, although if symptoms develop, this can be changed.  I have heard people with no symptoms going as long as 5 years between scopes.  It is a judgment call for you and Doc based on symptoms and history.

 

In the year after takedown, I recall several in office visits with my surgeon at which he manually scoped me and inserted finger up my rectum to inspect anal sphincter integrity.  This was not really maintenance per se but post-op.  After that I had pouchocopy at one year if I recall correctly.

CTBarrister
Last edited by CTBarrister

We have been seeing our surgeon continually since June.  That said, we saw him the entire summer as post op.  Then in Sept. my son had his takedown, and we saw him every two weeks.  Then we started with complications.  By Nov. we went to see the the gastro doctor, had a bunch of tests, admitted to hospital, back to the surgeon, and more surgery in March.  So basically, we have seen a doctor for 10 months on average every two weeks.  I'd like to say we are done, but he has another takedown surgery coming up Sept/Oct.  not sure how long we will continue to see the surgeon from this surgery.  

 

Dianne

Jeffsmom

It varies, depending on your individual case. However, what has me confused is why necessary follow up and/or maintenance would not be covered. Are you talking about denials from some supplemental insurance you have to cover something over and above the NHS coverage? I never heard of the NHS denying necessary exams requested by your doctor.

 

Jan

Jan Dollar

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