Major Insurer Planned to Limit Time of Anesthesia Coverage During Surgery
Anthem Blue Cross Blue Shield announced a plan to put time limits on anesthesia coverage in certain states, but now says it will not proceed with the plan.
The American Society of Anesthesiologists is calling on the provider to reverse the proposal immediately.
The policy was set to take effect on February 1, 2025.
Surgery isn’t always predictable. Complications happen. Even so, Anthem Blue Cross Blue Shield, a health insurance provider, plans to set limits on the anesthesia time it will cover in certain states. In other words, if a procedure takes longer than expected, patients may wake up to an unexpected bill. But now, the company says the plan is no longer.
“We have decided to not proceed with this policy change,” a spokesperson tells Prevention. “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.
The change was set to impact customers in Connecticut, New York, and Missouri effective February 1, 2025. In the official statements, the insurer said it planned to pre-determine the estimated number of minutes a procedure will take and that “claims submitted with reported time above the established number of minutes will be denied.” Exclusions include patients under the age of 22 and maternity-related care.
Since the announcement, the American Society of Anesthesiologists (ASA), which sets the standard for insurance claims submitted by professionals, publicly denounced the proposed change.
“Anesthesiologists provide individualized care to every patient,” the ASA said in a statement. With this new policy, the organization fears anesthesiologists will be pressured to meet an “arbitrary” time limit, the statement reads, which could hinder quality of care before, during, and after surgery.
“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,” the ASA said.
“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, M.D., told the ASA. “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.”
Dr. Arnold also called the policy “egregious” and said it “breaks the trust between Anthem and its policyholders.” The ASA urges people concerned about the new policy to contact their state insurance commissioner or state legislator.
In Anthem’s announcements, the insurer advised people who disagree with claims filed under the new policy to “follow the claim dispute process as outlined in the Provider Manual.”
Now, it appears the proposal will no longer take effect.
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