Mass.- Blue Cross Blue Shield of Massachusetts (BCBSMA) implemented a new policy on Jan. 1 that eliminates coverage for monitored anesthesia for many patients undergoing endoscopic procedures, like a colonoscopy, and other procedures. BCBSMA is the largest health insurer in Massachusetts.
According to Becker’s Healthcare, a healthcare industry trade publication, “Patients with few or no comorbidities will no longer receive coverage.” Becker’s also said a 10-year-old study from the American Society for Gastrointestinal Endoscopy was the basis for the change by BCBSMA.
BCBSMA told Fierce Healthcare, a healthcare industry news organization, that “among the groups spared from the new policy are those with conditions that warrant a more regular cadence for colonoscopies, patients who have a failed procedure, patients with a fear of medical procedures and patients with a chronic condition that warrant the use of deep sedation.”
Many groups, including the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy and the American Gastroenterology Association, oppose the policy for fear patients will skip the procedure due to inability to pay. BCBSMA will still cover conscious sedation, a moderate form of sedation where the patient remains awake during the procedure.
A colonoscopy is one of the best known means of prevention of colon and rectal cancer. The procedure is used to look for changes — such as swollen, irritated tissues, polyps or cancer — in the large intestine (colon) and rectum. The procedure involves a long, flexible tube inserted into the rectum where a tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon, according to the Mayo Clinic. The procedure is recommended every 10 years for most people between ages 45 and 75, and often at an earlier age for those with a history of colon cancer in their family.
According to the U.S. Centers for Disease Control and Prevention (CDC), there were 2,436 new cases of colon or rectum cancer in 2020, a rate of 29 per 100,000 people. 925 died state-wide from color or rectum cancer the same year. From 2016 to 2020, a total of 593 deaths occurred in Worcester County. The death rate state-wide was 12 per 100,000 for men and 8.8 per 100,000 for women.
