Anthem Blue Cross Blue Shield has decided to backtrack on a controversial policy change that would have limited coverage for anesthesia services.
The move, which was slated to take effect in Connecticut, New York, and Missouri, generated significant backlash from both medical professionals and the public.
The policy, initially set to go into effect in February 2025, would have capped payments for anesthesia services based on a set time limit, regardless of how long a surgery or procedure actually took. The insurer had drawn from surgery time metrics provided by the Centers for Medicare and Medicaid Services (CMS) to establish these time thresholds. However, this approach was met with strong opposition from the American Society of Anesthesiologists (ASA), which argued that it ignored the complex, variable nature of surgical procedures.
Anesthesiologists noted that the policy would have been unprecedented, as no major insurer or government program had ever implemented such a limit on anesthesia time. They emphasized that surgeries can vary greatly in duration, with patient needs dictating how much time is required for anesthesia care. Dr. Don Arnold, president of the ASA, criticized the policy as a “money grab” and a potential risk to patient safety.
In response to the public outcry, state officials in Connecticut and New York pushed back against the change. Connecticut Comptroller Sean Scanlon announced that the policy would not affect his state, after direct conversations with Anthem. New York Governor Kathy Hochul also intervened, calling the policy “outrageous” and stating that she would ensure New Yorkers were protected.
The insurer explained its decision to reverse the policy by citing “significant widespread misinformation” surrounding the changes. Anthem clarified that it had never intended to deny medically necessary anesthesia care and that the updated policy was meant to align with established clinical guidelines. In a statement, the company assured that anesthesia services would continue to be reimbursed based on medical necessity, but emphasized that time-based adjustments could be made in cases where documentation does not support the charges.
This change came amid broader concerns about health insurers’ policies, following the tragic killing of UnitedHealthcare’s CEO in New York City, which had already cast a spotlight on contentious decisions within the industry. The reversal of the anesthesia policy serves as a reminder of the delicate balance insurers must strike between controlling costs and ensuring patient safety.
With input from the Associated Press, Axios, and the New York Times.
