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Highmark backtracks on policy not to pay for anesthetic during colonoscopies

Luis Fábregas
| Tuesday, Dec. 23, 2014, 11:36 p.m.

Health insurer Highmark Inc. has stepped back from a proposal to stop paying for full anesthesia for some patients undergoing colonoscopies, a spokesman said Tuesday.

The controversial plan called for changes in the insurer's coverage of propofol, a general anesthetic that some experts say makes patients more comfortable.

Propofol, which was linked to the death of Michael Jackson in 2009, will continue to be used for the commonly performed colonoscopies, said Highmark spokesman Aaron Billger. During the examination, doctors use a thin tube to look at the colon. The test helps doctors find tumors, ulcers and polyps.

“Highmark medical policy is based on clinical evidence and patient safety. For that reason, Highmark will continue its policy,” Billger said.

In May, Highmark said it was considering the change because propofol can affect breathing and blood pressure. It said the change was not related to cost. Studies show using propofol can add several hundred dollars to the cost of a procedure.

The Pennsylvania Society of Anesthesiologists praised the insurer's decision, saying it is in the best interest of patients. The doctors group, which has about 1,900 members, lobbied against the proposal. Doctors worried that using only conscious sedation instead of full anesthesia would discourage patients from seeking colonoscopies.

“If you can detect colon cancer early, your outcomes are actually very good,” said Dr. Robert Campbell, the society's president and an anesthesiologist in Lebanon, Pa. “If you detect it late, it's fatal.”

Campbell said full anesthesia makes patients more comfortable and cooperative during the colonoscopy procedure. This allows doctors to conduct a more thorough evaluation.

“When you do colonoscopy with adequate anesthesia, you get a better study and detect more polyps ... and cancer detection is higher,” he said.

If a physician deems it appropriate, colonoscopies can be performed with moderate sedation during which the patient is partly conscious. Highmark has said in some cases it would be appropriate to use that form of anesthesia on some patients.

“The physician decides what's best, as always,” Billger said.

Luis Fábregas is Trib Total Media's medical editor. Reach him at 412-320-7998 or lfabregas@tribweb.com.

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