Massachusetts Insurer Restricts Anesthesia for Colonoscopies

If your doctor told you there would be no anesthesia for your scheduled colonoscopy, would you have the procedure anyway?

Blue Cross Blue Shield of Massachusetts now restricts the use of anesthesia during colonoscopies, and healthcare professionals fear it could discourage some folks from having the important procedure.

FierceHealthcare.com says a new Blue Cross Blue Shield policy that took effect January 1, 2024, "will restrict coverage of monitored anesthesia care (MAC) for patients undergoing endoscopic procedures like colonoscopies." The site says, "The coverage restriction also applies to bronchoscopy and certain pain procedures."

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The American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and the American Gastroenterology Association have protested the decision, saying it will lead to less safe clinical conditions for patients and a lower overall quality of care.

Blue Cross argues that many low-risk patients can be safely examined while sedated but awake.

This Week In Worcester cites the trade publication Becker's Healthcare, which reports, "Patients with few or no comorbidities will no longer receive coverage." Becker says, "Among the groups spared from the new policy are those with conditions that warrant a more regular cadence for colonoscopies" and others, including "patients with a fear of medical procedures."

A colonoscopy is one of the best-known means of prevention of colon and rectal cancer. They are used to detect and remove polyps from the colon that could become cancerous. Colonoscopies are recommended for most people 50 and older.

Massachusetts National Public Radio station WBUR says, "The policy change means that more patients with Blue Cross insurance will be asked to stay awake with moderate sedation for their procedures." The station says, "In some cases, patients who receive anesthesia could be responsible for the cost, which can run in the hundreds of dollars or more."

Blue Cross says anesthesia adds between $150 to $1,500 to the cost of an endoscopy procedure. The insurer says it processes claims for about 75,000 such procedures annually.