Anesthesia Reimbursement Policy Shift Sparks Change at Anthem Blue Cross

Surgeons performing an operation under bright lights.

Anthem Blue Cross Blue Shield abandons controversial anesthesia reimbursement policy after facing widespread criticism and safety concerns.

At a Glance

  • Anthem BCBS reverses proposed policy limiting anesthesia reimbursements in Connecticut, New York, and Missouri
  • American Society of Anesthesiologists and government officials strongly opposed the policy
  • Anthem cites “significant widespread misinformation” as reason for not proceeding
  • Critics argued the policy could compromise patient safety and quality of care

Anthem’s Controversial Policy Reversal

Anthem Blue Cross Blue Shield has decided to reverse course on a controversial anesthesia reimbursement policy that was set to take effect in February 2025. The policy, which would have affected Connecticut, New York, and Missouri, aimed to limit reimbursements for anesthesia during surgeries and medical procedures. This decision came after significant backlash from medical professionals, particularly the American Society of Anesthesiologists (ASA), and intervention from government officials.

The proposed policy would have capped anesthesia coverage based on pre-set time limits, potentially leaving patients uncovered if procedures ran longer than expected. Critics argued that such time constraints should be determined by surgeons, not insurers, and raised concerns about the policy’s potential to undermine quality care.

Widespread Opposition and Concerns

The American Society of Anesthesiologists led the charge against Anthem’s proposed policy, characterizing it as an unprecedented and potentially dangerous move. The ASA’s strong stance resonated with medical professionals and caught the attention of government officials.

“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.” – ASA

New York Governor Kathy Hochul and Connecticut’s Comptroller Sean Scanlon were among the prominent figures who intervened, leading to the policy’s reversal. Their involvement underscored the significant public and governmental pressure faced by Anthem.

Anthem’s Response and Clarification

In response to the backlash, Anthem decided not to proceed with the policy change. The company cited “significant widespread misinformation” about the update to their anesthesia policy as the reason for their reversal.

“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change. 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 proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.” – Anthem

Anthem emphasized that they never intended to deny reimbursement for medically necessary anesthesia. The company stated that the policy was meant to align with clinical guidelines and prevent potential overbilling by anesthesia providers. However, this explanation did little to quell the concerns of medical professionals and policymakers.

Implications and Future Considerations

The controversy surrounding Anthem’s proposed policy has sparked broader discussions about healthcare reimbursement practices and the balance between cost control and patient care. New York State Senate Deputy Majority Leader Michael Gianaris announced plans to introduce legislation to prevent similar policies in the future, indicating that this issue may lead to regulatory changes.

“This was so much out of left field. We’ve never seen anything like this.” – ASA President Don Arnold, M.D.

The incident has also highlighted the ongoing tension between insurance companies and healthcare providers over reimbursement policies. As the healthcare landscape continues to evolve, stakeholders will likely remain vigilant about proposed changes that could impact patient care and safety.

Sources:

  1. Anthem Blue Cross Blue Shield Reverses Controversial Anesthesia Reimbursement Policy After Backlash
  2. Anthem BCBS drops controversial new plan to cap anesthesia coverage after backlash

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