Aetna to stop paying for anesthesiologists during colonoscopies

Many physicians say eliminating coverage for some anesthesia is tantamount to discouraging patients from being screened for colorectal cancer.

By Emily Berry, AMNews staff. Feb. 4, 2008.

At a January meeting between Aetna representatives and one of Atlanta's largest gastroenterology groups, about 50 doctors handed over letters of resignation, threatening to pull out of the insurers' network.

They were protesting a change in Aetna's policy regarding anesthetizing patients undergoing colonoscopies, said Steven J. Morris, MD, managing partner of Atlanta Gastroenterology Associates.

As of April 1, Aetna is ending coverage of anesthesiologist-supervised sedation in endoscopy procedures.

Physicians, including Dr. Morris, are appealing to Aetna to rethink their decision. Opponents say the move will discourage people afraid of the procedures from being screened for colon cancer. And for some, the very idea of Aetna declaring anything medically unnecessary is an affront.

"We have an insurance company telling us to change the standard of care," Dr. Morris said. "This is a ridiculous situation."

Aetna is not alone in changing policy. Humana made a similar change last year. WellPoint did the same in June 2006, though spokesman Jim Gavin said, "Our clinical guidelines can be implemented across the country at the option of our health plans," so the rule isn't enforced everywhere.

For decades, physicians have used a combination of a narcotic and a benzodiazepine, which can put a patient in a conscious sedation. Doctors differ in their opinions of that method.

"These drugs have inconsistent and unpredictable effects," said Steven J. Stryker, MD, a surgical oncologist and professor of clinical surgery at the Northwestern University Feinberg School of Medicine in Chicago.