Blue Cross Blue Shield of Mass. pauses colonoscopy policy changes


Health

The insurer paused its policy, which changed anesthesia eligibility requirements for a colonoscopy procedure, citing “confusion about the policy and the reasons for it.”

Anesthesiologists work with a surgeon at Newton-Wellesly Hospital. John Bohn / Globe Staff

Blue Cross Blue Shield of Mass. has postponed planned changes to their colonoscopy policy

The policy stated that monitored anesthesia care (MAC) for endoscopic procedures, like a colonoscopy, would only be covered when deemed “medically necessary.” This would mean that certain patients who might previously have received MAC would instead only be eligible for moderate sedation, which leaves the patient conscious during the procedure.

The diagnoses and conditions considered when determining MAC eligibility are outlined in the policy, but include alcohol abuse, diabetes, and epilepsy, to name a few.


  • General anesthesia not ‘medically necessary’ for a colonoscopy, says one of state’s biggest insurers

This is the second time the so-called policy 154 has been paused. The initial postponement pushed the policy’s implementation from July of 2023 to Jan. 1, 2024 after criticism from doctors. In particular, gastroenterologists raised concerns that the new policy could result in nervous patients postponing their procedures, or not getting them at all.

Now, less than a month later, the policy has been postponed “until further notice,” according to a BCBSMA alert directed to “anesthesiologists and gastroenterologists caring for our members.”

Mass. Medical Society president Dr. Barbara Spivak expressed gratitude at the policy postponement. 

In a written statement, Dr. Spivak stated, “Patients should have agency, with input from their trusted physician and care team, over the method of sedation used.”

The statement also cites current struggles in the healthcare system, specifically staffing challenges involving endoscopists who lack the experience to administer moderate sedation, that will be alleviated by BCBSMA’s decision. 

According to the National Colorectal Cancer Roundtable, Mass. has the highest rate of colonoscopy screenings in the nation at 76%. Colorectal cancer remains the second most deadly form of cancer. Doctors recommend that adults over 45 should receive a colonoscopy every 10 years.

BCBSMA stated they will announce any further policy changes at least 90 days before enforcement. 





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