A Blue Cross Blue Shield of Massachusetts policy that was set to begin Jan. 1, and drew criticism from national gastroenterology groups for its restrictive changes, is being postponed to an unspecified date, the health plan announced Wednesday.
The policy would have limited coverage of monitored anesthesia care for some patients undergoing endoscopic procedures like colonoscopies. Advocacy groups and associations warned implementing the new policy would lead to less safe clinical conditions, worse care outcomes and fewer screenings, among other concerns.
But the state health plan said that is has decided to pause implementation due to confusion that has surrounded the new policy.
"The confusion stems from inaccurate information about our coverage for the different types of sedation available to members for these procedures," shared BCBSMA Director of Media Relations Amy McHugh in a statement with Fierce Healthcare. "The purpose of our action was to ensure that our members receive the type of sedation most clinically appropriate for them and consistent with national medical guidelines. Given the confusion, we’ve decided to pause enforcement of this policy while we work to make sure our members understand all their options for colon cancer screening and sedation and that they feel confident they’re getting the care that’s best for them."
Patients classified as ASA class I or class I, often the individuals without accompanying comorbidities, would not have been eligible for MAC under the postponed policy.
The Massachusetts Gastroenterology Association (MGA), along with the Massachusetts Medical Society, American Society for Gastrointestinal Endoscopy and other groups, have been in discussions with BCBSMA for several months trying to convince the insurer to rescind its policy.
"We are pleased that BCBSMA has officially paused the implementation of this restrictive sedation policy, and that claims denied after Jan. 1, 2024, will be retroactively approved, ensuring continuity of care for our patients," said MGA President Lauren Bleich. "We appreciate BCBSMA's openness to continued dialogue and their acknowledgment of the policy's potential impact on our medical community. The MGA will maintain an active role in working with BCBSMA to prioritize patient health in any future policy considerations."
"We will continue to work with out fellow gastroenterology societies, physician and patient advocacy groups, state and federal policymakers and the broader health care community to oppose any policies that limit patient access to life-saving colonoscopy and other endoscopic procedures that prevent cancer," the Digestive Health Physicians Association said in a LinkedIn post.
It's unclear how long the policy will be delayed, though the health plan's announcement said it would give 90 days advanced warning should the insurer decide to enforce the policy again.