Aetna Policy Change - No Full Sedation for Colonoscopies
NOTE: For Self-Funded Groups Only

Aetna has established a new clinical policy for anesthesia services for routine upper and lower gastrointestinal (GI) endoscopic procedures such as colonoscopy. Aetna will continue to cover conscious sedation or twilight sedation, for patients at average risk or with no sedation-related risk factors.

WHAT DOES THIS MEAN TO YOU AS AN EMPLOYER?
Effective April 1, 2008, Aetna will no longer cover monitored anesthesia care, which requires the presence of an anesthesiologist or anesthetist, unless it is medically necessary.

Conscious, or moderate, sedation is the method used by the majority of gastroenterologists and colorectal surgeons in this country when performing colonoscopies and upper endoscopies. It may be administered by the doctor performing the procedure. Conscious sedation or twilight sedation is a safe and generally well-tolerated choice for most patients undergoing upper endoscopy or colonoscopy.

For patients who have sedation-related risk factors like illness or other medical conditions, Aetna will continue to cover monitored anesthesia care for GI endoscopic procedures. Such individuals include children, the elderly, pregnant women, people with a significant medical condition or danger of airway compromise, or people who have other complicating factors.

Aetna is basing their policy on a broad base of evidence.

Aetna claims their policies are consistent with published statements from nationally recognized professional health care organizations and government agencies. For this new policy specifically - Respected professional organizations have stated that monitored anesthesia care is not necessary for routine cases for the reason stated below:

• No evidence that monitored anesthesia care is necessary for most patients.
• Need to keep insurance affordable for employers and individuals who purchase it.
• Alignment with the published policy statements of many other health plans and regional Medicare carriers.

Aetna will be contacting participating providers about this change and they are also planning to contact members to encourage preventive screenings and communicate details about this new policy.

WHAT SHOULD I DO NEXT?
If you choose to opt out of the policy:

• You will need to notify Aetna by February 28, 2008.
• Claims for monitored anesthesia care during endoscopic procedures, under this clinical policy bulletin, will be paid and not subjected to medical necessity review.
• You will need to add coverage for this benefit into your plan.

• Want to learn how to control costs?
• Want to be paperless?
• Out of compliance?
• Want employee communications?
• Want to learn more about us?