'There is confusion': Blue Cross Blue Shield of Mass. delays change in colonoscopy coverage
Blue Cross Blue Shield of Massachusetts will delay a controversial change in insurance coverage for endoscopic procedures that was to take effect Jan. 1.
The move comes after the Telegram & Gazette reported this week that Blue Cross planned to cover the more common full sedation for the procedures, including colonoscopy, but only if a doctor determined full sedation was a medical necessity.
Short of that, Blue Cross would cover moderate sedation.
Some doctors and health care providers opposed the change, saying it would limit access to colonoscopies and potentially compromise patient safety. Others claimed Blue Cross was trying to cut costs because full sedation is more expensive compared to moderate sedation.
Blue Cross cited confusion about the policy as the reason for the delay.
“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,” said a prepared statement by Dr. Sandhya Rao, chief medical officer and senior vice president at Blue Cross Blue Shield of Massachusetts.
“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.”
Rao noted in the T&G story that Blue Cross changed the policy to meet updated guidelines from the American Society of Gastrointestinal Endoscopy. The guidelines point to health risks associated with full sedation. As a result, Rao said the insurer is following the guidelines, so its members have access to high-quality, safe and affordable care.
Blue Cross processes claims for about 74,000 colonoscopy patients yearly in Massachusetts and a majority are done under full sedation.
A colonoscopy screens for colorectal cancer, the second-leading cause of cancer-related deaths in the U.S., according to the American Cancer Society.
Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.
This article originally appeared on Telegram & Gazette: Blue Cross Blue Shield of Mass. delays change in colonoscopy coverage
