To protect public-school and state employees from surprise medical bills, the employees' health plans should start paying for general anesthesia for routine colonoscopies, an advisory panel recommended Tuesday.
The Quality of Care subcommittee of the State and Public School Life and Health Insurance Board made the unanimous recommendation after hearing a presentation from G. Richard Smith, a professor and former dean at the University of Arkansas for Medical Sciences.
Adding the coverage could cost as much as $1.2 million per year but would reduce patients' recovery time and complaints about out-of-pocket costs, Smith said.
The extra cost could be offset, he said, if more employees receive colonoscopies and cases of colon cancer are prevented or caught early.
The health plans, which cover about 45,000 school employees and 27,000 state employees, currently cover conscious sedation for preventative colonoscopies. Anesthesia, in which the patient is rendered unconscious, is covered only in special cases when it's considered medically necessary.
In a one year period ending Sept. 30, 1,529 patients appealed the plans' denial of coverage for anesthesia for preventive colonoscopies, Smith said. The coverage was granted in 283 of those cases, he said.
The average cost to the plan was $962 for a colonoscopy with conscious sedation and $1,291 for a colonoscopy with anesthesia, he said.
Studies show little difference in complications resulting from conscious sedation or general anesthesia, he said.
Some doctors believe they can perform a more thorough exam when general anesthesia is used, although research hasn't shown an advantage for one approach over the other, he said.
The subcommittee's recommendation will go to the full board for a final decision.
Metro on 04/14/2016