Why all the restrictions on Cologuard?

Since I have avoided getting a colonoscopy, my MD recommended Cologuard. He said BCBS covers it. Just to be sure I emailed BCBSIL and this was there response:

Service 81528 (Oncology colorectal screening) requires medical review be completed by our medical review unit prior to the determination of coverage. Your doctor who has ordered this test will need to submit a predetermination request that includes the procedure code, diagnosis code, Patient history and physical, listing of all prior colon rectal cancer screenings in the last 10 years and family history of colon cancer. Once this documentation has been received it will be reviewed and benefits will be given.

Looks like BCBSIL is trying to discourage use with the hoops you have to jump through. Why is that?

Parents

0 BCBSIL Connect Team over 8 years ago

Good morning, Certain procedures do require review to make sure they are eligible under medical policy criteria and your plan's benefits. Cologuard is one such service. Your provider can submit the requested documentation to have this reviewed. ~ Kayla
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0 BCBSIL Connect Team over 8 years ago

Good morning, Certain procedures do require review to make sure they are eligible under medical policy criteria and your plan's benefits. Cologuard is one such service. Your provider can submit the requested documentation to have this reviewed. ~ Kayla
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Children

0 Agrippa over 8 years ago in reply to BCBSIL Connect Team

Yes, but why? Looks like "corporate speak" for "we don't want to pay for this."
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Why all the restrictions on Cologuard?