Insurer won't pay for colonoscopy ane...

Insurer won't pay for colonoscopy anesthetic

There are 24 comments on the Chicago Tribune story from Dec 28, 2007, titled Insurer won't pay for colonoscopy anesthetic. In it, Chicago Tribune reports that:

Another insurer plans to clamp down on the use of a powerful anesthetic during an increasingly common form of colon cancer screening.

Join the discussion below, or Read more at Chicago Tribune.

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Tamara Phalen

Denver, CO

#1 Dec 28, 2007
Way to go insurers! While you are at it, why don't you just eliminate anesthesia for ALL medical procedures? Let's just go back to the Middle Ages!

I personally would like to have one, or all, of these healthcare CEOs go on TV a la Katie Couric and have a colonoscopy done without anesthesia on live TV so we can see their reaction to the procedure. Not that that is likely to happen anytime soon. Pathetic.
Sheila

United States

#2 Dec 28, 2007
Let's see the CEO of Aetna get his butt reamed with an instrument without the aid of an anesthetic.
INSURERS SUCK

Los Angeles, CA

#3 Dec 28, 2007
An obvious ploy by the insurance companies to encourage people to NOT get checked for colon cancer.
Dr Crippen

Itasca, IL

#4 Dec 28, 2007
INSURERS SUCK wrote:
An obvious ploy by the insurance companies to encourage people to NOT get checked for colon cancer.
Right Suck, the insurance companies don't have to pay if you're dead, and maybe that's the point.

To further cut costs, I'd next expect them to lobby the AMA and Congress to allow you to operate on yourself after taking an Internet course.

Since: Oct 07

New Lenox, Illinois

#5 Dec 28, 2007
Okay Aetna, you take a camera all the way up the wazoo (to the stomach!) without benefit of anesthesia first.
Dienne

United States

#6 Dec 28, 2007
As is often the case these days, this story leaves some holes that need filling. For starters, are these insurance companies saying they won't pay for ANY anesthetic, or just this particular one? Are there others used instead? I've known quite a number of people who've had colonoscopy's and all of them have been drugged. I can't fathom having NO anesthetic. Furthermore, I can't fathom any doctors saying that anesthesia is not medically necessary.
Older guy

Chicago, IL

#7 Dec 28, 2007
I guess I am kissing my a** goodbye. I certainly cannot afford a steep cost for a routine medical screening. I pay about $1,000.00 extra a year in dental that my insurer won't cover. When will health care get some needed relief for the working poor
icky story

Chicago, IL

#8 Dec 28, 2007
I had a colonoscopy in the 1980s and never went back for another one. Here's why: I apparently wasn't given enough anesthesia and woke up during it. I was in a bizarre twilight state; I was in pain, had no idea where I was or that I was having a procedure and thought I was being attacked. I started yelling, trying to pull the tube out and hitting the nurse and doctor as they tried to stop me. Apparently they got the anesthesia going again, as the next thing I remember is waking up in the recovery room. Nightmare. Never again.
Boogie Woogie

United States

#9 Dec 28, 2007
I've had two colonoscopies - first one I was completely unsuspecting - the general practitioner performed it at a hospital without anesthesia.

The pain was overwhelming - I have a lot of scar tissue from earlier surgery which caused some of it. He kept saying just a minute more.... LIAR!

I was thoroughly shaken and worn out after the ordeal and could barely drive myself home.

For years I refused to have another - this new doctor was on my case for a couple of years about why I was being so stubborn about having another.

I explained my prior experience and learned I would not feel anything due to the "amnesia" medication Iwould be receiving. I agreed but with trepidation. I had no pain. I will never have another one if I cannot have anesthesia.

How expensive is this stuff anyway?
Nontech

Port Angeles, WA

#10 Dec 28, 2007
Dienne wrote:
As is often the case these days, this story leaves some holes that need filling. For starters, are these insurance companies saying they won't pay for ANY anesthetic, or just this particular one? Are there others used instead? I've known quite a number of people who've had colonoscopy's and all of them have been drugged. I can't fathom having NO anesthetic. Furthermore, I can't fathom any doctors saying that anesthesia is not medically necessary.
I agree, but the effect of this announcement will be that lots of people who were nervous about getting this life saving test will now put it off even longer. I watched my dad die of colon cancer and wonder how the decision makers here will sleep at night after being responsible for needless deaths.
Bebop

Mishawaka, IN

#11 Dec 28, 2007
In our country we smoke the opium for this procedure. no worries.
propofol

Philadelphia, PA

#12 Dec 31, 2007
Dienne wrote:
As is often the case these days, this story leaves some holes that need filling. For starters, are these insurance companies saying they won't pay for ANY anesthetic, or just this particular one? Are there others used instead? I've known quite a number of people who've had colonoscopy's and all of them have been drugged. I can't fathom having NO anesthetic. Furthermore, I can't fathom any doctors saying that anesthesia is not medically necessary.
hi
no- they arent saying that they wont pay for anesthesia- but what that means is that GI sedation will go back to the way it was- the GI doctor and his nurse will give a narcotic/benzosiazepine combination (fentanyl/versed, demerol/versed,etc.) The propofol given by an anesthesiologist is a newer thing. It caught on because of the Deep Sedation it provided with patient comfort, quicker recovery, etc.
There are 3 levels of sedation- Conscious sedation, moderate sedation, deep sedation. They all have different risks (yes, deep sedation is riskier than conscious sedation and studies show that sedation can be as risky as General Anesthesia.)

But that is not saying that the "old drugs" wont work- they just dont work as well depending on the patient. Plus, the old safety factor- the GI doctor has to watch the screen he is working on, AND the vital signs monitor. Some places require a separate person to be involved with the sedation other than the "surgeon", irrespective of the drug being given.
But, realize what drives all of this- money. The GI docs saw their reimbursement go down while the anesthesiologist's stayed the same or slightly higher. The whole insurance revolt started because of the GI docs doing studies saying that they can give propofol themselves without an anesthesia provider- they show low incidence of problems. Once these studies started coming out, that was all the fuel that was needed for the first insurance company to have an excuse to stop paying. However, some of the studies- the physycian was in a hosiptal GI lab and had ICU nurses with him. So, what does that say to the GI doc in his office with a regular RN? These guys now placed this burden on all the other GI docs who DONT want to give their own sedation for safety,medicolegal, etc reasons.

But you are right- the CEOs (even the ones who perform poorly and still get a $20 million bonus) will still show up and get their propofol, and have it given by an anesthesia provider (CRNA or Anesthesiologist.) The corporate world is an entirely diffent level of living.
Dienne

United States

#13 Dec 31, 2007
propofol wrote:
<quoted text>
hi
no- they arent saying that they wont pay for anesthesia- but what that means is that GI sedation will go back to the way it was- the GI doctor and his nurse will give a narcotic/benzosiazepine combination (fentanyl/versed, demerol/versed,etc.) The propofol given by an anesthesiologist is a newer thing. It caught on because of the Deep Sedation it provided with patient comfort, quicker recovery, etc.
There are 3 levels of sedation- Conscious sedation, moderate sedation, deep sedation. They all have different risks (yes, deep sedation is riskier than conscious sedation and studies show that sedation can be as risky as General Anesthesia.)
But that is not saying that the "old drugs" wont work- they just dont work as well depending on the patient. Plus, the old safety factor- the GI doctor has to watch the screen he is working on, AND the vital signs monitor. Some places require a separate person to be involved with the sedation other than the "surgeon", irrespective of the drug being given.
But, realize what drives all of this- money. The GI docs saw their reimbursement go down while the anesthesiologist's stayed the same or slightly higher. The whole insurance revolt started because of the GI docs doing studies saying that they can give propofol themselves without an anesthesia provider- they show low incidence of problems. Once these studies started coming out, that was all the fuel that was needed for the first insurance company to have an excuse to stop paying. However, some of the studies- the physycian was in a hosiptal GI lab and had ICU nurses with him. So, what does that say to the GI doc in his office with a regular RN? These guys now placed this burden on all the other GI docs who DONT want to give their own sedation for safety,medicolegal, etc reasons.
But you are right- the CEOs (even the ones who perform poorly and still get a $20 million bonus) will still show up and get their propofol, and have it given by an anesthesia provider (CRNA or Anesthesiologist.) The corporate world is an entirely diffent level of living.
Thanks for the info. Wish the reporter could have included some of that.
Chris

Westbury, NY

#14 Aug 3, 2008
Well, I have found this website and discussion months after the initial posts when I googled something to the effect of "When health insurance won't pay for anethesia." It WAS a colonoscopy prodcedure. The insurance company would not allow an in-office procedure, so I had to go to the hospital (same Gastroenterologist). I had to sign forms two minutes before clothes where taken off. My insurance company payed a teeny, tiny fraction (30% or 80%) of the doctor's fee. WTF! The insurance company paid less than $300.00 I now have a bill that is nearl $1200.00! I appealed (after trying to get answers from them for months on the steps to take in order to appeal). I received a very snotty letter back indicating that they may have actually reimbursed the anesthesiologist too much, and they could request a reimbursement from me (between the lines: "Consider yourself lucky that we're not requiring you to pay us back). My goodness. I should have just hat this at the doctor's office. Again, WTF!
Reckless

Lake Villa, IL

#15 Aug 3, 2008
Gee, and I am scheduled for one on the 20th,guess I'll be sitting on a donut afterward.
scaredycat

Meridian, ID

#16 Aug 9, 2008
I just had a colonoscopy yesterday... scared to death.. but that's incredible what happened to you you in the 80's... unbelievable... dangerous too.. my surgeon met with me prior and there is ALWAYS some risk of perforation.. hate to think how high that risk goes when the patient freaks out and tries to pull things out... I"m so sorry that happened to you... they were crazy to do it that way.... may be why MOST do it this way now... the pre-op nurses did tell me that all but ONE of their doctors use anesthesia now... but still there is that ONE... I think it's crazy.... by the way... depending on your age etc... you SHOULD get one again if your doc recommends it... but be sure your doc /surgeon uses anesthesia... I was just lying there... and talking to the anesthetist and WHAM.. out like a light.. didnt know ANYTHING.. until they called my name and told me it was all over ... best way to do it!! Good luck next time. and hey to everyone else.. the insurance companies are crazy too!! Our system really does need help!!
Juana

United States

#17 Aug 9, 2008
No anesthesia? YEEEEEOOOOOOOWWW! NO WAY!
jcrn

Chicago, IL

#18 Jun 10, 2009
I did it without sedation. No big deal - and if I save money on the anesthetic (still waiting to hear about that), I'll be even happier. It was like watching a documentary - of my lower intestines. Fascinating!
heather

Alexander, AR

#19 Oct 27, 2009
there is a difference between "anesthesia" and "conscious sedation". the insurance company WILL pay for conscious sedation (versed, demerol, benedryl, morphine, etc) it will not pay for the propofol (diprivan). nearly all GI patients are comfortable during conscious sedation and the conscious sedation drugs have an amnesia effect so there are usually no unpleasant memories. anesthesia is mostly reserved for patients with a medically necessary reason: COPD, CAD, extreme anxiety, advanced age, etc. discuss options with your doctor and they can help you to find a medical term and support for it to get the insurance companies to pay for safety and comfort.
abbie

Mount Vernon, OH

#20 Feb 3, 2010
No way would I do a colonoscopy with sedation. I do much better and am a lot more relaxed when I am awake and can watch. I would not have a repeat colonoscopy if I had sedation! Why do doctors want to cram sedation/anesthesia into us for every procedure? Good for the insurance companies standing up to these doctors!

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