Sunday, March 02, 2008

Who should make the decisions? Your health insurer or your doctor?

March 2, 2008: This article from Yahoo news brought to you as a service from Dr. Steven Horvitz and the Institute for Medical Wellness.

Aetna postpones sedation policy change

By STEPHEN SINGER, AP Business WriterWed Feb 27, 6:00 PM ET
Aetna Inc. said Wednesday it will delay a proposed policy that would stop covering the cost of using anesthesiologists during colonoscopies. The policy had been opposed by a group of New Jersey doctors who said denying coverage of anesthesiologists to anxious patients would lead to fewer cancer screenings.
The Hartford-based insurer's policy was to take effect Apri1 1. Aetna said it will now be implemented after the U.S. Food and Drug Administration approves other forms of sedation.
"Implementation of our policy on April 1 would inconvenience our members ... and potentially depress cancer screening rates in the short term," said Dr. Troyen Brennan, Aetna's chief medical officer.
Aetna initially announced its policy in December in an attempt to address questions about the medical necessity of an anesthesiologist's services during routine upper and lower endoscopic procedures, such as colonoscopies. Aetna would still cover anesthesiologists for high-risk patients.
The change was opposed by the Medical Society of New Jersey, which said patients should be assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.
A call was placed to the group seeking comment.
Aetna has said moderate sedation works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.
Aetna said it hopes delaying the policy will allow adequate time for new "attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services" to be approved by the FDA.
New medical devices, as well as new sedatives, are expected on the market during the late summer and are in review with the FDA now, Aetna said.
Once that occurs, Aetna will implement its policy, Brennan said.
Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.


This is another example of health insurance companies dictating treatments for patients, against their doctors wishes. Aetna's motives were solely to cut costs and increase already soaring profits. For more on Aetna's 2007 earnings, totaling over 1.8 Billion dollars please click here.

Can you imagine how many of the uninsured could be helped with 1.8 billion dollars?

How about lowering your health insurance premiums with some of the 1.8 billion dollars?

So to believe that Aetna's decision not to pay for colonoscopy anaesthesia was good for patient care is disingenuous. After reading the above article, the questions you must ask are who you want to help you in making medical decisions, your doctor or your health insurance carrier? I vote for doctors making the decisions!

One of the main reasons I dropped out of insurance networks was to be able to offer all my patient's unbiased yet affordable family medical care without any third party interference. By not contracting with these billion dollar profit making health insurers, I can truly be your best advocate to get you through this healthcare system.

As we are now two months into our new insurance-free system, I ask all of my patients for comments on how I can make my practice work better for you both today and in the future. Any and all comments are appreciated.

I also ask for suggestions on future newsletter topics. I try to get recent newsworthy items of interest and read between the lines to put it into proper unbiased perspective. Please send any suggestions to me by email at

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness
Your Partner in health!

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