Sat 8 Apr 2006
I got forwarded an interesting letter asking me to write my congressperson and others about Blue Cross denying anesthesia benefits for colonoscopy and endoscopy procedures.
The text went: “They have removed the accessibility and coverage of anesthesia for colonoscopies and endoscopies. They want insured’s to go through these procedures without the benefit of anesthesia. If you want anesthesia they want you - the insured to pay for it and not the medical plan. Prior to November 2005, the various Blue Cross plans provided anesthesia for these procedures.”
A colonoscopy or endoscopy can be pretty uncomfortable from what I hear. But, was what I was reading the full story? Were the insurance companies expecting patients to suffer without any form of relief?
Having been online for 12 years now and having received a lot of alarming letters that turned out to be lies or half-truths, I researched it. And what turned out to be the half truth was using “anesthesia” without qualifying it.
The three types of anesthesia I know about are local anesthesia, sedation, and general anesthesia. If you’ve ever had a shot of Novocaine at the dentist’s office, you’ve had local anesthesia. If the dentist gave you gas in addition to the shot, you added sedation to the mix. If you were given a drug to knock you out so that you wouldn’t notice the pain, you had general anesthesia.
What I discovered was that Blue Cross is denying is not anesthesia in general, but general anesthesia. Basically, they’re willing to pay for the doctor to do things to make you more comfortable, but not for you to be knocked out, which adds hundreds of dollars to the bill.
In particular, they are refusing to cover the use of Propofol, a fast-acting anesthetic that also has a somewhat fast recovery time (i.e. it knocks you out quicker, but also wears off quicker). But the farther you go under, the greater the risk that you could stop breathing or have other complications. Generally, if you’re knocked out, an anesthesiologist needs to be present. And while some medical groups say monitoring by a well-trained nurse is sufficient, other doctors don’t want to take the risk of not having an anesthesiologist present. Either way, the drug is expensive and the additional staff to monitor the patient adds to the expense.
Normally, colonoscopies are performed with a conscious sedation, generally induced with a benziodiazepine (such as Valium) and/or a narcotic. I had conscious sedation with Valium in addition to Novocaine when I had my wisdom teeth pulled and I was just fine. And while I suspect a 1+ hour oral surgery for removing impacted wisdom teeth hurts a heck of a lot more than a 15-minute colonoscopy, I haven’t had a colonoscopy, so I can’t say.
But a tube that size going up your rectum is not only uncomfortable, it’s embarrassing and feels violating. I can understand if people want to be asleep, not just to avoid the physical discomfort, but the emotional discomfort as well. If they’re knocked out, they don’t have to “lay back and think of England”, so to speak. Additionally, some doctors and patients preferred Propofol because you’re not as dopy/sleepy for as long afterward as you might be with sedatives. And for a while, Blue Cross paid for this.
Blue Cross said they’d decide on a case-by-case basis whether the patient’s particular situation necessitated putting the patient to sleep vs. a conscious sedation. Some of the cases in which such sedation or monitored anesthetic care would be waranted are discussed in this article at the American Gastroenterology Association’s web site.
Now here’s the question… Are doctors who offer Propofol as an option telling their patients that their insurance company may not cover it? Are they informing patients that it may cost $400 or more extra, out of pocket, if they opt to be knocked out instead of receiving drugs that will help with the discomfort, but leave them conscious?
Since my conscious sedation was part of a gruelling dental procedure, I can’t say if it’s as effective for a colonoscopy or endoscopy. Is it really painful, even with the drugs that don’t knock you out? If it’s bearable, is the option of being knocked out a doctor trick that pads the bill by playing to your fears (or your need to get back to your go-go lifestyle faster)? Or is Blue Cross denying patients genuinely necessary pain relief, as suggested in the letter I got?
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April 8th, 2006 at 1:29 pm
How interesting that you would bring this up…
I work in colorectal cancer research, talking to many patients who’ve had colonoscopies. From what they’ve said, I think the general anesthesia is more of an incentive, actually. I think doctors are trying to make it so easy/comfortable that there’s no excuse for the patient to avoid getting a colonoscopy.
There aren’t too many people begging to have all five feet of their colons scrutinized. But there are lots who’d be happy to run far, far away from the prospect, unless the person could be unconscious during the event. So I think doctors may be essentially offering patients a chance to “go to a happy place”, rather than to be aware of every last minute of the procedure.
May 15th, 2006 at 5:06 pm
What happened to me is that the insurance company said that the doctor doing to procedure could have done the anesthesia and would not pay anything to the non-participating anesthesologist. What annoys me is that the surgeon doing the procedure calls the insurance companies first with the procedure code and no one alerts them that there has been a change in policy. No pun intended but you’re not in a position to have a dialogue about this on the table! The anesthesiologist that attended to me (at my surgeon’s direction) has taken by bill into collection while I appeal to my insurance (GEHA). At first they offered to reduce the $1170 bill to $720 but when I didn’t pay they took that offer off the table when it went to collection. Ironically, the surgeon only received $358 from the insurance company and they expected the surgeon to do both.
I am all in favor or prudence in the medical field but I felt I was gamed by the anesthesologist who probalby knew this was a developing problem.
January 24th, 2007 at 1:13 am
I know the surgon told the Anistegist to go easy on the drug that puts you out cause it cost so much. they did and I kept comming to,and in sever pain , like last stages of labor pain. I did this three or four times during the test and each thim begged the to stop ,but ofcource the surgon didn’t. it was horribal and I would rather go on worring than ever have that done again !
May 25th, 2007 at 9:56 am
There is no way in hatties anyone could ever get me to undergo a colonoscopy without anesthesia. More people’s lives could be saved by providing a pain free procedure. There is no excuse that this procedure should not be covered by medical insurance and if people are poor or don’t have coverage they too should be entitled to medical care - after all this is AMERICA.
December 12th, 2007 at 9:05 am
Colonoscopies, done by a skilled practitioner, should require just a small dose of pain-killer (ie:fentanyl) for the really tough spots (rounding the corners)….especially in wonem..men have fairly straight colons……….just had one…..specified no drugs; versed and or propofol cause short-term and sometimes long term memory loss…these are not harmless drugs; not is colonoscopy a “drive thru” procedure…………….if you could stand labour pains, drug-free colonoscopy is a breeze………….having to pay for “anesthesia” is ridiculous….