Del. companies urged to pick up costs of colonoscopy sedation

News Journal, February 9, 2008

Aetna Inc.’s decision Thursday to restrict coverage of a doctor-preferred anesthetic used during colonoscopies prompted a harsh rebuke from the governor and other state leaders.

Aetna Inc. has told doctors, that as of April 1, it will restrict coverage of propofol, used during colonoscopies.

Doctors fear the move will discourage patients from getting the cancer screening because propofol makes patients more comfortable.

In response, Gov. Ruth Ann Minner announced Friday that state employees would not be affected by the announcement. The state will pay for it using its tax dollars.

She was joined by insurance commissioner Matt Denn and state treasurer and gubernatorial candidate Jack Markell, who has had three colonoscopies, all fully sedated. They urged large Delaware companies that are self-insured through Aetna to do likewise. Among them are Du Pont, Avon, Computer Science Corp. and Liberty Mutual Insurance.

Patients in need of colonoscopies besieged Dr. Joseph Hacker’s office on Friday.

Since Aetna Inc. announced that it will no longer cover full sedation for the procedure, patients are calling to get an appointment before the deadline.

“We’re getting them in but the schedule is getting tighter,” said Hacker, a gastroenterologist in Stanton.

Dr. Robert McDonough of Aetna, an internist, disagreed with state officials and local doctors, who have said that the lack of full sedation would deter patients from getting screened.

“We’re aware of no empirical evidence that the attendance of an anesthesiologist, or the use of propofol sedation, affects colon-cancer screening rates,” said McDonough, the head of clinical policy research and development. “In most areas of the country, screening is done without the anesthesiologist, using moderate sedation.”

Hacker said the lack of evidence is due to a paucity of comparative studies on the issue.

“If I have to go back to having them lightly sedated, a guy may be leaving this place and telling family and friends about a bad experience,” he said. “The rate of colon-cancer screening goes down and the colon-cancer [mortality] rate goes up.”

Only 12 percent of Aetna colonoscopy patients are sedated in Chicago, which is located in Cook County. According to the National Cancer Institute, 21.8 to 23.6 of every 100,000 residents in Cook County died from colorectal cancer. In Delaware, the death rate is 19.7 out of every 100,000.

In Delaware, thousands of cancer screenings have been financed by the state. They have been credited with leading to early detection as well as dropping Delaware’s death rate.

Sandra Lehman says her colonoscopy three years ago saved her life.

The 67-year-old Bethany Beach resident found out she had colorectal cancer and had to go through chemotherapy. Now she’s cancer-free. The colonoscopy was easy to undergo because she was fully sedated.

“First of all, people are afraid of a colonoscopy because they say it’s going to be painful,” she said. “They think they’ll be embarrassed. It’s not the most pleasant thing to think about. But if you’re on sedation, you’re not going to feel the discomfort.”

Her private insurance at the time covered the full sedation.

“I would pay for it with my own money” if sedation wasn’t covered now, she said.

Denn said pricey medical treatments can be avoided through early screening.

“We’ve seen the mortality rate go down, so this is just a step in the wrong direction,” he said.

Thousands of reminders are sent to patients to emphasize the importance of getting screened, McDonough said.

The move is expected to shave $300 to $1,000 off the cost of the procedure. Aetna has about 95,000 subscribers in Delaware. The insurance company covers about 9,000 state employees, pensioners and their dependents.

Lori Captain, spokeswoman for DuPont, indicated that a decision would be made in a few weeks. Roughly 14,500 DuPont employees nationwide participate in the Aetna program.

“DuPont is reviewing Aetna’s new medical necessity protocol and determining appropriate next steps,” she said.

If Aetna does not reverse its decision, Denn said he will appeal to the General Assembly to consider making a new rule for companies that work with Aetna and aren’t self-insured. It would require that insurers continue to cover full anesthesia for those companies’ patients during a colonoscopy.

“But my hope is that Aetna will reverse its policy,” Denn said.

And if it doesn’t, Claymont resident Mike Cattermole has a suggestion for Aetna colonoscopy patients:

“It looks like the other alternative will be to take some Valium beforehand and chug some Jack Daniels.”