Insurer will delay plan to stop covering sedation during colonoscopies

The News Journal, February 28, 2008

Aetna Inc., amid an outcry from doctors, patients and state officials in Delaware and elsewhere, on Wednesday backed away from its plan to stop paying for the services of an anesthesiologist to sedate patients during many routine colonoscopies.

Instead of implementing the policy starting April 1, the insurer said in a statement it will delay any changes “until patient-friendly alternatives — which will not require the added expense of an anesthesiologist — are approved by the Food and Drug Administration and available in the marketplace.”

The postponement applies nationwide, and the company has set no timetable for changing its coverage policy, said Susan Millerick, an Aetna spokeswoman.

“We have determined that in those few markets where monitored anesthesia care has become the routine approach to sedation, implementation of our policy on April 1 would inconvenience our members in those markets and potentially depress cancer screening rates in the short term,” Dr. Troyen A. Brennan, Aetna’s chief medical officer, said in the release.

The decision prompted praise from physicians and state officials in Delaware, who spoke out fiercely against the policy immediately after media reports detailing the change.

“I’m very pleased patients are going to get the level of sedation they should,” Dr. Joseph Hacker, a Stanton gastroenterologist, said. “It’s a win for patients.”

Aetna, the nation’s third-largest health insurer, with about 95,000 subscribers in Delaware, was blasted by a host of state officials in Delaware earlier this month after The News Journal reported the insurer’s new policy.

Gov. Ruth Ann Minner and other officials howled that the move, which Aetna said could shave between $300 and $1,000 off the cost of a colonoscopy, would jeopardize state efforts to screen more Delawareans for colon cancer, a disease that kills nearly 54,000 Americans each year.

Officials here feared that some Aetna members, if they weren’t fully sedated during a colonoscopy, would shy away from a procedure considered the gold standard for colorectal cancer screening. Doctors recommend the procedure for patients starting at age 50.

House Speaker Terry Spence, R-Stratford, said earlier this month he would introduce legislation requiring health insurers in Delaware to cover the cost of an anesthesiologist during colonoscopies.

Aetna, however, said at least three national studies proved most patients could be comfortably sedated by a gastroenterologist, and the use of an anesthesiologist is largely a regional phenomenon, popular in the Northeast, but less common in other parts of the country.

Aetna’s new policy, if continued, would limit coverage for an anesthesiologist’s services during colonoscopies to a smaller group of patients, including those at risk for complications, women who are pregnant, patients younger than 18 and those 65 and older.

Minner said in a statement Wednesday she was “pleased Aetna has reconsidered their earlier decision.”

Aetna, along with Blue Cross Blue Shield of Delaware, is one of two insurers that cover the state’s 110,000 workers and retirees, and Minner said earlier this month the state would continue to pick up the cost of an anesthesiologist for them.

Aetna’s planned change “was a step in the wrong direction and one that the state of Delaware would not follow,” she said.

Lt. Gov. John Carney, State Treasurer Jack Markell and State Insurance Commissioner Matt Denn also lauded Aetna’s change of mind.

Aetna executives made the rounds in Delaware on Tuesday, meeting jointly with Denn and Markell, and separately with Carney.

“We didn’t want to take a step backward,” Carney said.

State efforts, he said, will continue to focus on “making it as easy as possible for folks to get screened” for colon cancer.

“They indicated they received significant push back in Delaware, much more than they received in other states,” Markell said.

Denn said he’s waiting to see how the issue is finally resolved.

“In the short term, it’s good news,” he said. “But we’ll have to see what kind of alternatives they’re talking about.”

DuPont Co., which uses Aetna for its health plan, also said it would continue to cover the services of an anesthesiologist for its workers and retirees.

Millerick, the Aetna spokeswoman, said the insurer received between 800 and 1,000 e-mails, letters and phone calls from subscribers and doctors, a tally she called “a fair amount of feedback.”

Most of the people the company heard from were unhappy with Aetna’s original decision to limit coverage and some mistakenly believed they would have to endure a colonoscopy without any sedative at all.

The insurer plans to undertake an education campaign later this year emphasizing the importance of colon cancer screenings and informing subscribers about their anesthesia options, Millerick said.

Dr. Michael Katz, a Wilmington anesthesiologist, said that while Aetna’s decision is “a step in the right direction,” he’s concerned it won’t lead to a permanent change.

“It indicates they may still look in the future to step between the physician and the patient, to determine what’s best for the patient,” he said.

Hacker, the gastroenterologist, said Aetna’s initial decision to restrict coverage was a concern for many of his patients, who rushed to schedule colonoscopies before the April 1 deadline. “It’s probably safe to say that I’ve heard from 100 patients,” he said. “It’s been a very hot topic of discussion by my patients.”