‘Anthem BCBS drops controversial new plan to cap anesthesia coverage after backlash’ | USA Today

As published in USA Today:

After receiving intense backlash, a health insurance provider has rolled back its plan to implement a new policy that would have limited its coverage for anesthesia used during procedures.

Elevance Health, which recently rebranded from Anthem Blue Cross Blue Shield, first shared information about the proposed change for Connecticut, New York and Missouri via news releases posted Nov. 1, though the news only just started gaining traction this week. In some instances, provider notices were sent to specific states as recently as Dec. 1, which may have contributed to the delayed reaction.

Delayed or not, the public backlash has been fierce and swift. According to a description of the policy on Anthem’s website, billing guidelines would change in some states beginning in February 2025 to cap the amount of anesthesia care the company would cover based on time limits pre-set by the insurer.

This would mean that if a patient’s procedure ran long, the insurer would not pay for the care, the American Society of Anesthesiologists (ASA) said in a statement posted last month calling for the move to be reversed.

The proposition concerned not only members of the public, who began making tongue-in-cheek comments online about being woken up mid-surgery to swipe a credit card, but professional organizations, doctors and lawmakers alike.

ASA dubs move ‘profits over patients’

The ASA first sounded the alarm on the policy in a statement released on Nov. 14, calling the decision “another example of insurers putting profits over patients.”

“In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes,” said the opening of the statement.

It linked to an administrative announcement posted by Anthem on Nov. 1, indicating an update to anesthesia billing time units. The notice explained that as of Feb. 1, 2025, Anthem would change how it evaluated billing for anesthesia services using “Center for Medicaid Services (CMS) Physician Work Time values.”

Under the new process, a “target number of minutes” would have been set for anesthesia services. Claims that included ongoing anesthesia care past that established number of minutes would be denied, the release said.

Exclusions for patients under the age of 22 and maternity-related care were built in, said the blurb, and professionals who disagreed with a denial could appeal through a standard process.

In an earlier statement to FOX61 Connecticut, Anthem said the change was meant to “improve affordability and accessibility” by implementing practices to “safeguard” its insured against “potential anesthesia provider overbilling.”

“Anthem strives to help make health care simpler and more affordable,” read the statement. “One of the ways to achieve that goal is to help ensure that claims are accurately coded, and providers are reimbursed appropriately for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”

Professionals, officials respond

The ASA, along with some vocal elected officials, vehemently disagreed with Anthem’s characterization of the billing regulations.

“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said ASA president Donald E. Arnold in the association’s statement. “It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care.”

The association contended that anesthesiologists provide individualized care that depends on a series of factors, including existing health conditions, the condition being treated, needs that arise during the procedures and care that begins in the pre-operative and extends into transitional and recovery stages.

In a letter sent to Anthem Blue Cross Blue Shield Connecticut on Nov. 20, Connecticut State Sen. and practicing oncologist and hematologist Jeff Gordon inquired as to why the insurance providers would set time limits on covering anesthesiology time during procedures.

“Is there research or data that supports the company’s policy on this matter? For patients, it raises the concern that profits are being prioritized over medical care,” the letter said. “It could lead to avoidable adverse events and/or unnecessary bad outcomes.”

Other officials, including New York Gov. Kathy Hochul and Sen. Chris Murphy, D-Conn likewise lambasted the decision in posts online.

Legislation proposed to combat Anthem anesthesia and similar policies

On Thursday morning, Connecticut Comptroller Sean Scanlon announced in a statement that the billing limits would no longer be put into place in the state after he “negotiated” with the company.

“After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I’m pleased to share this policy will no longer be going into effect here in Connecticut,” Scanlon said in a press release.