Blue Cross Blue Shield of Massachusetts (BCBSMA) has decided to postpone the implementation of a controversial policy that was initially set to begin on January 1, 2024. This policy, which drew criticism from national gastroenterology groups, aimed to limit coverage of monitored anesthesia care (MAC) for certain patients undergoing endoscopic procedures like colonoscopies.
Advocacy groups and associations had raised concerns that the new policy would lead to less safe clinical conditions, poorer care outcomes, and a reduction in screenings. In response to these concerns and the confusion surrounding the policy, BCBSMA has chosen to delay its enforcement. According to BCBSMA Director of Media Relations Amy McHugh, the pause is intended to clarify the coverage for different types of sedation available for these procedures and ensure that members understand their options for colon cancer screening and sedation.
Under the postponed policy, patients classified as ASA class I or II, typically those without accompanying comorbidities, would not have been eligible for MAC. The Massachusetts Gastroenterology Association (MGA), along with other medical societies, has been in discussions with BCBSMA for several months, advocating for the policy’s rescindment.
MGA President Lauren Bleich expressed satisfaction with the pause, noting that claims denied after January 1, 2024, will be retroactively approved, ensuring continuity of care for patients. The MGA plans to continue working with BCBSMA to prioritize patient health in future policy considerations.
The Digestive Health Physicians Association and other groups remain committed to opposing any policies that limit patient access to potentially life-saving colonoscopy and other endoscopic procedures that prevent cancer. The duration of the policy delay is unclear, but BCBSMA has promised to give a 90-day advanced warning if they decide to enforce the policy again.