Request for Advice on Filing an Appeal for Colonoscopy Coverage

Hi Redditors,

I recently received an unexpected $4,000 bill for a colonoscopy that I had expected my Aetna insurance to fully cover. After reviewing my policy, I realized that coverage for preventive colonoscopies begins at age 45, and I was 44 years and 8 months when the procedure was performed. This was an oversight on my part, as I misunderstood the age requirement.

Here’s the context I’m considering for an appeal, and I’d appreciate any advice you can provide:

Unawareness of Age Requirement: I wasn’t aware that being just a few months shy of 45 would disqualify the procedure from being fully covered as preventive care.

No Symptoms or Findings: I went in for the colonoscopy as a preventive measure, with no symptoms beforehand, and the procedure yielded normal results with no concerning findings.

Family Cancer History: While I don’t have a family history of colon cancer specifically, both of my parents tragically passed away at 54 from internal cancers—one from renal cancer and the other from pancreatic cancer. This influenced my decision to take early preventive steps.

Preventive Health Focus: Given this family background, I felt it was critical to undergo screening early to monitor my health proactively.

High-Deductible Health Plan: I’m on a high-deductible plan with a $6,500 annual deductible, none of which has been used so far this year.

I’m leaning toward requesting that Aetna reconsider the coverage due to the preventive nature of the procedure and my unique family medical history, despite being a few months under the covered age limit.

Do you have any advice on how to frame this appeal more effectively, or insights into whether this approach is likely to succeed? Any additional points I should include? I appreciate any guidance or thoughts here!