Docs oppose Aetna plan on colonoscopies

By STEPHEN SINGER, AP Business Writer

A group of doctors from New Jersey is opposing a plan by Aetna Inc. to drop coverage of a type of anesthesia used during colonoscopies.

Gastroenterologists and other doctors say patients anxious about colorectal screening may balk unless they are assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.

“The idea should be to encourage these procedures because of their lifesaving ramifications,” said John Fanburg, counsel for the New Jersey State Society of Anesthesiologists and the New Jersey Gastroenterology and Endoscopy Society.

Aetna says moderate sedation, which it will continue to cover, works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.

As of April 1, the Hartford-based insurer plans to continue to routinely cover moderate sedation, but limit coverage of so-called monitored anesthesia care by an anesthesiologist to patients who are at higher risk due to illness or other complications.

“Propofol works faster, but whether it results in improved patient satisfaction is difficult to prove,” said Robert McDonough, head of Aetna’s clinical policy unit.

New Jersey specialists are organizing other doctors to oppose the change, and have scheduled a meeting Feb. 15 with Aetna officials. Fanburg did not rule out a lawsuit.

“To the extent litigation is an option, we’re looking at all options,” he said.

Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.

Steven Morris, a gastroenterologist in Atlanta, said doctors have switched to propofol in the last several years because patients experience few side effects.

“For me to be able to tell patients they feel no discomfort helps people overcome their fears and anxieties,” he said.

However, McDonough said there is no evidence that the attendance of an anesthesiologist or use of propofol has an impact on screening rates.

Aetna is not alone in refusing to cover the cost of propofol for routine colonoscopies.

Humana said in a statement that medical evidence shows that sedation is just as effective as anesthesia. The insurer said it honors requests for exceptions for a “demonstrated medical necessity” for anesthesia during a colonoscopy.

Wellpoint’s policy is that medications such as propofol, administered by an anesthesiologist during endoscopic procedures, may be appropriate in limited circumstances but are not medically necessary. Such medications would typically not be covered by Wellpoint health plans that follow that guideline.

However, UnitedHealthcare covers propofol for routine colonoscopies “because it encourages our members to get screenings and hopefully save lives,” spokesman Tyler Mason said.
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