Re "Anthem's propofol policy discourages a vital procedure," Column, Oct. 18
David Lazarus is wrong to expect Anthem Blue Cross to cover propofol sedation for all colonoscopies. Many gastroenterologists such as myself perform colonoscopies under moderate sedation and with good outcomes.
Propofol administration mandates the presence of an anesthesiologist and is offered to many high-risk patients. But insurance coverage of propofol use, purely for patient comfort and preference, is not justified despite its benefit of deeper sedation and rapid reversal. This agent is often used to facilitate "assembly line" colonoscopies.
I would be surprised if most doctors actually agreed with the views of the physicians Lazarus quotes. He should have surveyed a larger cohort of gastroenterologists to provide a balanced view.
Jacob Korula, MD
As an Anthem subscriber, I think it fair that every bean counter in the company have two colonoscopies about a week apart — one with propofol and one without. Then they can make an informed decision about what is "medically necessary" for a colonoscopy.
There is no reason for a patient to suffer unnecessary pain during a colonoscopy. Unfortunately, many patients will delay the procedure rather than suffer any pain, leading to more too-late diagnoses of colon cancer.
Physicians should follow the lead of those who got Aetna to backtrack from its anti-propofol effort in 2008 and get Anthem to reverse its cruel decision.
Propofol is the most used drug to induce general anesthesia. There is a fine line between sedation and unconsciousness. Propofol also depresses heart and lung function (think Michael Jackson).
When used, it should be administered by a person whose only job is to sedate and care for the patient. That person should be qualified in cardiac resuscitation and life support, and also be able to recognize and rescue a lost airway to prevent hypoxic brain damage.
As an anesthesiologist, I prefer that person to be an anesthesiologist, but a qualified nurse anesthetist or trained intensivist would do.
A healthy person may not need the extra level of comfort, convenience and safety provided by an anesthesiologist, but look around: How many healthy, non-obese Americans do you see?
Eva Segovia, MD
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