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07/23/2014: "Big Insurance: “and throw a little sand in there too…”"


Filed under: Healthcare,insurance,Legal/Law,Pharmacology,Rx Meds " kurtglmft @ 2:31 pm
Tags: Aetna, Anesthesiologists, Endoscopy, Gastroenterology, New Jersey, propofol, United Healthcare, Wellpoint


I don’t know if everyone will get the reference in the title, but I thought it was fitting. In another example of Big Insurance trying to prop up their already fat bottom line, comes this from the Wall Street Journal's Health Blog. By the way, this is what happens when MBA’s make medical decisions instead of MDs.

Aetna is about to cut back on its coverage of a popular, but expensive, form of anesthesia for patients undergoing colonoscopes, the AP reports. Docs aren't pleased.

Doctors say the fast-acting drug Propofol makes colonoscopes more comfortable (or at least less uncomfortable). But it's use often requires that an anesthesiologist be present, and boosts the cost of the procedure by $200 to $1,000. Insurers argue that "moderate sedation," which combines painkillers and a sedative, works equally well for most patients and doesn't require the presence of an additional specialist.

WellPoint cut back on its coverage of Propofol a few years back. As of April 1, Aetna will pay for an anesthesiologist to be present during a colonoscopy only in cases where the patient would be at high risk without one. United Healthcare covers Propofol during colonoscopy, according to the AP.

Some gastroenterologists and anesthesiologists are working with lawyers to fight the change. "To the extent litigation is an option, we’re looking at all options," said John Fanburg, counsel for the New Jersey State Society of Anesthesiologists and the New Jersey Gastroenterology and Endoscopy Society.

I have an idea, lets have the "insurers" who made this decision undergo the procedure the way they want everyone else to. Wonder if that would change their mind. smile


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