BlueCross BlueShield of North Carolina is standing by its policy that deep sedation should only be used for procedures when medically necessary, according to a letter from Eugenie Komives, MD, vice president & senior medical director of BCBSNC, sent to the North Carolina Medical Society.
Dr. Komives indicated that communications about the policy raised some concerns for physicians and indicated BCBSNC would withdraw, until further notice, the medical necessity attestation requirement for use of deep sedation with GI endoscopy procedures. However, BCBSNC is still expecting compliance with the medical necessity policy and is reserving the right to do a "retrospective pattern reviews" to identify instances of noncompliance.
The letter also indicated that BCBSNC would continue to allow practices to continue to obtain propofol sedation-specific waivers for cases not meeting the medical necessity requirements, and practices could then bill the patient for the waivered service.
"It appears that BCBSNC is not opposed to patients receiving propofol sedation for gastrointestinal endoscopy procedures, as long as they do not have to pay for it," says David Kadish, president of Medi-Corp. "They are increasing their revenues at the expense of their members and possibly forcing members, that can't afford this additional expense to skip the procedure entirely."
Thank you to Medi-Corp for assisting with this article.