This is probably done to combat the increasing use of elective colonoscopies, which is costing insurers money:
The American Gastroenterological Association issued a statement Monday charging the insurer’s pending new policy on performing outpatient endoscopies “will hinder the medical judgment of physicians as to the proper setting for endoscopic procedures, based on the specific needs of individual patients.” According to the medical group, Blue Cross of California, starting July 1, will financially penalize doctors who opt to perform endoscopic procedures in an outpatient hospital setting.“By providing financial disincentives to physicians who perform endoscopic procedures in a hospital outpatient setting, the policy subverts the physician’s ability to make decisions of medical necessity or for reasons of safety when a patient with significant other medical problems should have their endoscopic procedure in a hospital outpatient setting,” the AGA said, adding, “If the policy is implemented, California physicians will be penalized for making clinical judgments for the sake of achieving cost savings for the insurer and their shareholders.”
In most cases, colonoscopies can only be done at a hospital setting. This penalty is likely a way to discourage screening colonoscopies – which is really too bad. But insurance companies don’t really have the patients’ best interests in mind.
