Blue Cross Blue Shield of Massachusetts postpones anesthesia policy
The policy would have limited coverage during colonoscopies and other procedures, prompting industry pushback.
Photo: Thomas Barwick/Getty Images
On January 1, Blue Cross Blue Shield of Massachusetts implemented a policy that would have limited coverage of monitored anesthesia care for certain patients receiving colonoscopies and other endoscopic procedures. But due in part to pushback from the anesthesiology community, the insurer is delaying the policy until further notice.
According to WBUR, the policy drew ire from doctors concerned that it would slow their productivity and perhaps discourage patients from getting endoscopic procedures due to fear of discomfort and pain.
That prompted BCBSMA to issue a notice on its website, saying that, after careful review, "we have decided to postpone the claim edits that enforce this medical policy until further notice." The insurer told anesthesiologists that it would notify them 90 days in advance of any future enforcement of the policy.
At the same time, BCBSMA reiterated that it covers monitored anesthesia care for endoscopic procedures, such as colonoscopies and upper endoscopies, "when medically necessary."
"Medical policy 154 lists diagnosis codes and clinical scenarios where monitored anesthesia care is medically necessary for endoscopic procedures, outlined by certain medical conditions and complication risks," the insurer said.
The notice claims that this medical policy aligns with guidelines from the American Society of Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology, the American Gastroenterological Association, and the American Society of Anesthesiologists (ASA).
WHAT'S THE IMPACT?
That last group, the American Society of Anesthesiologists, called the delay of the policy a "significant victory," particularly given that the change is retroactive to January 1 – meaning no claims will be rejected for payment.
"We are grateful that BCBSMA ultimately heeded our warnings about the potential impact on cancer screening access and patient choice in GI care," the ASA wrote.
The big sticking point for the ASA and other groups was the level of sedation patients receive during colonoscopies and other endoscopic procedures. Anesthesia induces "deep sedation," which puts patients to sleep, but BCBSMA had maintained that some patients don't need to be put to sleep and can be sedated while staying awake, which is known as "moderate sedation."
The insurer had signaled it would deny coverage to those who didn't meet certain criteria, such as a history of chronic conditions or fear of medical procedures.
Gastroenterologists had argued that anesthesia promotes more efficient, higher-quality exams, according to WBUR.
THE LARGER TREND
Colon cancer screenings are recommended for those between the ages of 45 and 75.
National estimates say using anesthesia during a colonoscopy can add between $150 to $1,500 to the procedure's total cost, according to WBUR. Blue Cross covers more than 74,000 such procedures annually.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
