Anthem halts plans to limit anesthesia coverage
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Key takeaways:
- Anthem’s policy would have capped its reimbursement of anesthesia if surgery went over a set time limit.
- The reversal comes after Anthem received widespread criticism from medical groups and the public.
Anthem Blue Cross Blue Shield announced it would no longer move forward with its plans to limit the length of time it would cover anesthesia provided during surgery and other procedures.
The announcement comes after the insurance company, one of the largest in the country, received substantial criticism from the public and anesthesiologist groups.
“There has been significant widespread misinformation about an update to our anesthesia policy,” Anthem said in a press release. “As a result, we have decided to not proceed with this policy change.”
The proposal to the policy “was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines,” Anthem said in the release. “Any medically necessary anesthesia would have been paid under the update.”
Under the proposal — first announced Nov. 1 — Anthem would have stopped its reimbursement of anesthesia if the procedure or surgery went over a set time limit, “regardless of how long the surgical procedure takes,” according to the American Society of Anesthesiologists (ASA).
The policy update would have been implemented in Connecticut, Missouri and New York beginning in February.
In a press release, ASA had called the move “unprecedented,” citing its potential to negatively affect the delivery and safety of care, especially for patients “who may need extra attention because their surgery is difficult, unusual or because a complication arises.”
“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,” Donald E. Arnold, MD, FACHE, FASA, president of ASA, said in the release. “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.”
According to NBC News, an Anthem spokesperson said the policy aimed to “safeguard against potential anesthesia provider overbilling” amid the company’s “continuous efforts to improve affordability and accessibility to care.”
The proposal gained significant attention after the fatal shooting of UnitedHealthcare CEO Brian Thompson, drawing ire and action from officials like New York Gov. Kathy Hochul.
“Last night, I shared my outrage at a plan from Anthem to strip away coverage from New Yorkers who had to go under anesthesia for surgery," Hochul said in a statement Thursday. "We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy.”
Anthem said in its release that it remains “highly committed to reducing waste and the cost of care for consumers and ensuring that care providers are reimbursed appropriately for the services provided to members.”
References:
- Anthem Blue Cross Blue Shield won’t pay for the complete duration of anesthesia for patients’ surgical procedures. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures. Published Nov. 14, 2024. Accessed Dec. 6, 2024.
- Fattah M, et al. Anthem Blue Cross Blue Shield halts anesthesia payment policy after backlash. NBC News. Available at: https://www.nbcnews.com/health/health-care/anthem-blue-cross-blue-shield-time-limits-anesthesia-surgery-rcna183035. Published Dec. 5, 2024. Accessed Dec. 6, 2024.
- Statement from Governor Kathy Hochul. Available at: https://www.governor.ny.gov/news/statement-governor-kathy-hochul-37. Published Dec. 5, 2024. Accessed Dec. 6, 2024.
- Update to anesthesia billed time units policy. Available at: https://providernews.anthem.com/connecticut/articles/update-to-anesthesia-billed-time-units-policy-23311. Published Dec. 5, 2024. Accessed Dec. 6, 2024.
Perspective
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As an orthopedic surgeon with decades of experience advocating for patient-centered care, I am astonished by Anthem Blue Cross Blue Shield's recent proposal to tether anesthesia coverage to subjective time limits. While the company has halted this plan and officially stated, “the policy was only designed to clarify the appropriateness of anesthesia,” its implications and motivations raise significant concerns about their integrity and accountability to patient care.
Anthem claimed its proposal aligned anesthesia services with “well-established clinical guidelines.” However, limited scientific evidence supports arbitrary time frames as a determinant of appropriate anesthesia use. Clinical care varies with patients' anatomy, surgical complexity and unforeseen intraoperative challenges. A subjective cap on anesthesia ignores these variables, prioritizing administrative policies over evidence-based care.
Surgical teams would have been pressured to conform to insurance-directed time frames, detracting from their focus on patient outcomes. Time constraints would increase stress in the OR, compromising intraoperative decision-making and patient safety. In some cases, prematurely concluding procedures could lead to adverse outcomes, undermining the purpose of medical care.
Proposals like these are driven by financial motivations rather than clinical considerations. Retrospective payment denials based on arbitrary time frames shift financial risk onto providers, discouraging comprehensive care. While efficiency is important, it should never come at the expense of quality and safety. Policies prioritizing profits over patients are antithetical to the mission of health care.
Anthem’s decision to halt the policy was reactive rather than proactive, following widespread criticism from professional organizations, providers and patient advocates. Future decisions must involve clinicians and rely on robust evidence instead of subjective cost-containment strategies.
Increased accountability and oversight are critical in preventing harmful policies. Regulatory intervention may become necessary if insurers continue proposing initiatives that risk compromising care. Government oversight can protect patients and providers from policies prioritizing corporate profits over clinical judgment. Financial incentives or administrative policies should never interfere with health care professionals' duty to provide safe, effective and compassionate care, especially in the OR.
This incident highlights the need for constant vigilance and advocacy to uphold the principles of high-quality surgical care. Patients deserve better, and as their advocates, we must continue championing policies that reflect our shared commitment to their well-being.
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