Under pressure, insurance giant reverses decision to not pay full length of anesthesia

⚫ Anthem BCBS to cap anesthesia payments
⚫ Anesthesiologists rail against ‘concerning’ policy

⚫ Outrage leads to backtrack

Anthem Blue Cross Blue Shield announced new limits on covering anesthesia for most surgeries in a few states — leading to such public outrage that the health insurer backed off its plan within hours on Thursday.

Anthem BCBS plans representing New York, Connecticut and Missouri had declared that they would pre-calculate how long anesthesia care should be for a surgery or procedure, starting in February 2025.

Anthem HealthKeepers, an independent licensee of the Blue Cross Blue Shield Association, also announced the new limits would start in Virginia.

Anthem Blue Cross Blue Shield said in a statement that its decision to backpedal resulted from “significant widespread misinformation” about the policy.

The insurance giant’s policy change came one day after the CEO of UnitedHealthcare, another major insurance company, was shot and killed in Manhattan.

If a procedure were to go beyond the estimated time limit, with a few exceptions, the extra expense would be out of pocket for the sedated patient, starting in February 2025.

The new time limits on covered anesthesia care would not apply to maternity-related care or patients younger than 22.

As of Thursday, the webpage for Horizon BCBS covering New Jersey did not show the same change in "billed time units." Anesthesia time units are calculated in 15-minute intervals.

In detailing the new billing process, the health insurance company cited as a resource the American Society of Anesthesiologists.

The American Society of Anesthesiologists called for Anthem to reverse the policy “immediately.”

“With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises,” a joint statement by the ASA said on Thursday.

Patients who disagree with a claim reimbursement decision would be expected to navigate the usual insurance red tape, as Anthem said they would “follow the claim dispute process as outlined in the Provider Manual. Documentation to support your request will be required.”

“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, Dr. Donald Arnold.

“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,” he continued.

“This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need.”

The anesthesiologists society, which represents more than 59,000 professionals, also pointed to Anthem’s recent profits amid its concerning limitations.

Under its corporate name Elevance Health, Anthem reported a 24.12% increase in its year-over-year net income to $2.3 billion and a 24.29% increase in its year-over-year net profit margin in June.

ASA urged people concerned about Anthem’s proposal to contact state insurance commissioners and lawmakers — a tactic that appears to have worked in Connecticut, first.

By late afternoon, Anthem Blue Cross Blue Shield said in a statement that its decision to backpedal resulted from “significant widespread misinformation” about the policy, the Associated Press reported.

“To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” the statement said.

“The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”

The billing updates for the now ditched time limits would have meant patients undertaking an appeal process, if extra time was not initially approved.

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