UPDATE | Announcement Highmark Delays Change In Anesthesia Policy for Colonoscopies

MAY 30 2014 UPDATE | Announcement Highmark Delays Change In Anesthesia Policy for Colonoscopies

Today, Highmark announced that is has decided to “delay implementation” regarding the manner in which they pay for Monitored Anesthesia Care (MAC). Due to concerns expressed by the medical community, legislatures, employers and patients, Highmark has determined that it requires additional time and input before implementing such an impactful change to patient care. As Highmark continues to assess this decision (see the Regional Gi FAQ and analysis below), it becomes very important for patients, and employers who cover their staff with Highmark health insurance plans, to speak out. If you have concerns about this proposed change, please contact your local legislature and Highmark.

Until further notice, Regional Gi will continue to schedule Highmark patients providing the appropriate level of anesthesia, including MAC, as we have prior to the original Highmark announcement.

If you have any questions, feel free to call us at (717) 869-4600. But, you should consider sharing your opinion with Highmark. They can be reached at member services (800) 345-3806.

POSTED MAY 24TH

Highmark has decided that beginning June 30th, 2014 they will no longer cover Monitored Anesthesia Care (MAC) for endoscopic procedures for average risk patients. This decision, which we feel is a shortsighted approach to preventative care in general, currently impacts those covered by Highmark.

At Regional Gi, patient care is of the utmost importance, so it is necessary that those affected by this change in coverage are informed and any concerns are addressed. Therefore, we have compiled a list of common questions below.

Please contact Highmark for more information or to register a concern or call member services at (800) 345-3806

Who made the decision?
This decision was made solely by Highmark

When will this be effective?
Our understanding is it is effective June 30

What does it mean to me?
Highmark will no longer pay for monitored anesthesia care for average risk patients undergoing colonoscopy and other endoscopic procedures. You are considered to be at average risk if you do not have any significant underlying health conditions, you have never had problems with sedation in the past and your physician does not anticipate that you will be intolerant of moderate sedation. Monitored anesthesia care is the administration of a medication known as Propofol by an anesthetist who is specifically qualified and credentialed to administer this type of sedation which is termed deep sedation. Deep sedation induces a state of sleep and ensures maximal patient comfort. If a patient wants to receive deep sedation with Propofol it will now be an out of pocket expense.

Will I get any sedation?
Yes you will receive moderate sedation. You should not experience severe pain but you may be aware of what is happening and you may experience some degree of discomfort. This type of sedation can be administered by an RN who is supervised by a gastroenterologist. You will be in an altered state of awareness and will be able to respond to general commands. Moderate sedation has been used safely by gastroenterologists for many years and was used extensively by our providers prior to the advent of deep Propofol sedation.

Will there be any additional possible side effects of moderate sedation?
It is very possible that your procedure and recovery time will be longer, and you will feel more “groggy” after the procedure.

Is there anything I can do about this?
Contact Highmark and share your opinion and/ or convey your dissatisfaction with their decision. It is not too late to prevent Highmark from making this change. You could also contact your State Senator and Representative and tell them of your concern with Highmark and their decision.

What is Regional Gi’s position regarding this?
At Regional Gi we will do whatever it takes to ensure the safety and quality of care that we provide to our patients. We believe that this decision by Highmark is not in the best interest of the community and reflects a shortsighted vision of the long term benefits of colon cancer screening and other GI procedures. In our opinion the ongoing use of Propofol anesthesia will allow us to most effectively minimize any discomfort and medication side effects associated with your endoscopic procedure.

Highmark 
Fifth Avenue Place
120 Fifth Avenue • Pittsburgh, PA 15222-3099
(412) 544-7000