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Hawaiian Insurer Discourages Full Anesthesia for Colonoscopy

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  • In Billing
  • October 15, 2010
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Guaranteeing full coverage of many preventive services, such as colonoscopies, without a co-pay, co-insurance, or deductible, is one of the new benefits Medicare beneficiaries are now entitled to under the Patient Protection and Affordable Care Act. At least one insurer, however, is saying that full anesthesia isn’t part of the package deal.

Hawaii Medical Services Association (HMSA) told in a statement that, per national guidelines and the insurer’s policy, full sedation should only be used when the patient is in the high-risk category. Otherwise, conscious sedation is more appropriate.
Unconscious sedation for colonoscopy is generally attained through the use of a drug called Propofol. This drug must be administered by an anesthesiologist or certified nurse anesthetist, which ultimately increases the cost of the colonoscopy by several hundred dollars more than if the procedure is performed under conscious sedation, administered by the physician.
Conscious sedation is more widely used by physicians performing colonoscopies, HMSA told Some physicians even prefer using no anesthesia at all. Regardless of physician and anesthesiologist preference, it’s the principle of the matter, some say.
“It feels like the insurance companies are trying to make that decision for the patient and for the physicians and we just don’t feel that’s appropriate,” anesthesiologist Dr. Curt Carson told
Carson said HMSA is discouraging full sedation by making it difficult to get authorization in advance—and then routinely denying claims several times, reports.

Anesthesia and Pain Management CANPC

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