Blue Cross Blue Shield of Massachusetts is pausing a controversial policy that went into effect Jan. 1 that limited coverage for the use of monitored anesthesia for certain gastrointestinal patients undergoing endoscopic, bronchoscopic or interventional pain procedures, including colonoscopies.
"Since then, it has become clear to us that there is confusion about the policy and the reasons for it. The confusion stems from inaccurate information about our coverage for the different types of sedation available to members for these procedures," Sandhya Rao, MD, chief medical officer for BCBSMA, told Becker's on Jan. 25.
"The purpose of our action was to ensure that our members receive the type of sedation most clinically appropriate for them and consistent with national medical guidelines.
"Given the confusion, we've decided to pause enforcement of this policy while we work to make sure our members understand all their options for colon cancer screening and sedation and that they feel confident they're getting the care that's best for them."
Under the policy, BCBSMA did not consider the use of monitored anesthesia medically necessary for certain procedures unless a patient received documentation by the operating physician or anesthesiologist/certified registered nurse anesthesiologist that specific risk factors or significant medical conditions were present. Patients classified as Class I or Class II patients, meaning they have no or few comorbidities, were not eligible for coverage under the paused policy.
Lauren Bleich, MD, president of the Massachusetts Gastroenterology Association, told radio station WBUR the policy made care access more difficult and made the healthcare system less efficient.
"It's caused a lot of confusion, a lot of angst," she told the news outlet. "Some patients have decided to cancel or postpone their procedures."
The policy is postponed until an unknown date. BCBSMA said it would offer 90 days' notice before any further changes, according to WBUR.