Blue Cross Blue Shield of Massachusetts (BCBSMA) has decided to pause planned changes to their colonoscopy policy, citing confusion surrounding the policy and its reasons. The policy, which initially raised concerns among doctors and gastroenterologists, aimed to alter anesthesia eligibility requirements for colonoscopy procedures.

Under the proposed policy, monitored anesthesia care (MAC) for endoscopic procedures, such as colonoscopies, would only be covered if deemed "medically necessary." This meant that some patients who would have previously received MAC would instead be eligible for moderate sedation, which allows the patient to remain conscious during the procedure.

The policy outlined specific diagnoses and conditions that would be taken into account when determining MAC eligibility, including alcohol abuse, diabetes, and epilepsy, among others. However, medical professionals expressed concerns that the changes might lead to nervous patients postponing or avoiding their colonoscopy procedures altogether.

This is the second time that the implementation of the policy, known as policy 154, has been postponed. It was initially pushed from July 2023 to January 1, 2024, following criticism from doctors. Now, less than a month later, BCBSMA has decided to postpone the policy "until further notice," as stated in an alert directed to anesthesiologists and gastroenterologists caring for their members.

Dr. Barbara Spivak, the President of the Massachusetts Medical Society, expressed gratitude for the policy's postponement. Dr. Spivak emphasized the importance of patients having agency and the ability to make decisions in consultation with their trusted physicians and care teams regarding the method of sedation used.

The statement from BCBSMA also highlighted ongoing challenges within the healthcare system, particularly regarding staffing issues involving endoscopists who may lack the experience to administer moderate sedation. The decision of BCBSMA to postpone the policy is expected to alleviate these concerns.

Massachusetts has the highest rate of colonoscopy screenings in the nation at 76%, according to the National Colorectal Cancer Roundtable. However, colorectal cancer remains the second most deadly form of cancer. Medical experts recommend that adults over the age of 45 should undergo a colonoscopy every 10 years.

BCBSMA has stated that any further policy changes will be announced at least 90 days prior to enforcement.