Costly Anesthesia: Waking Up To High Colonoscopy Bills

The costly issue of receiving anesthesia during a colonoscopy has become a hot topic.

While gastroenterologists often let patients decide how much sedation they'd like when they have the procedure, a growing number of patients are discovering that they've been put under by an anesthesiologist, or nurse anesthetist, who then charges extra for their services.

In some cases, this can leave the patient with unexpected bills that may not be covered or only partly covered by their insurer.

As National Public Radio reported in March, whether you're put under by an anesthesiologist may also depend a lot more on where you live and who gets paid than on patient preference, according to a study in the Journal of the American Medical Association.

For example, people in the Northeast are given anesthesia services 59 per cent of the time compared to 13 percent in Western states, where insurers have balked at paying the extra cost, deciding that most people do fine with sedation administered by the doctor.

The study, by the RAND corporation, found that use of anesthesia services has grown overall from just 14 percent of patients in 2003 to 30 percent by 2009. Most of that increase was for healthy people who didn't have a condition that would require anesthesia, NPR reported.

And this month, the New York Times reported on a husband and wife who each chose a gastroenterologist who participated in their insurance plan to perform their colonoscopies. Each spouse's doctor then chose full anesthesia administered by an anesthesiologist, who turned out not to be covered by the couple's insurance.

According to the Times, the couple are now fending off lawyers and a debt collection agency over thousands of dollars in unresolved charges.

Most patients who undergo the endoscopy procedure that allows doctors to check for colon cancer opt for "twilight sleep," also called "conscious sedation," that relies on sedatives to block pain and relax the patient during the exam, but allows them to remain conscious. The sedative dose is administered by the gastroenterologist.

In recent years, insurers have begun paying for anesthesia with propofol, a fast-acting drug that must be administered by an anesthesiologist or nurse anesthetist. Patients are fully anesthetized for the exam, but regain consciousness quickly.

Medicare covers the costs, as do some private insurers.

Gastroenterologists, who get paid the same whether they administer sedation or an anesthesiologist does, say they can work more efficiently and handle more cases if an anesthesiologist is involved. Some also say that patients recover more easily after full anesthesia, although there is no clear scientific evidence to support this, according to the Times.

Plus -- let's be honest -- many people prefer to be completely under during their colonoscopy, despite the extra cost.

So how do you avoid any unpleasant financial surprises following your colonoscopy? Ask lots of questions beforehand.

As the Times article recommends:

* Ask about what kind of anesthesia will be used and who is going to administer it.

* If your doctor insists on an anesthesiologist or a nurse anesthetist, you have two options: find a gastroenterologist who administers sedation on his or her own, or make sure the anesthesiologist is covered by your plan.

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