In November, Blue Cross Blue Shield Massachusetts announced that beginning Jan. 1, it would no longer cover the use of monitored anesthesia for certain gastrointestinal patients undergoing endoscopic, bronchoscopic or interventional pain procedures.
Now that the policy has officially gone into effect, monitored anesthesia is no longer considered “medically necessary” for these procedures by the insurer, unless a patient receives documentation by the operating physician or anesthesiologist/certified registered nurse anesthetist that specific risk factors or significant medical conditions are present.
Patients with few or no comorbidities will no longer receive coverage. BCBS cited a study from the American Society for Gastrointestinal Endoscopy published 10 years ago as the basis for the change, according to a gastroenterologist who spoke with Becker’s.
While the policy has only been in effect for a little over a week, some physicians are wary of its impact on patient care.
“This will obviously have a substantial ripple effect on access, efficiency and acceptance of colonoscopy as the preferred screening tool as anesthesia provided care is used in the majority of outpatient endoscopy centers here,” Max Tilson, MD, a physician with Chelmsford, Mass.-based Integrated GI Consultants, told Becker’s.