A new policy from one of the nation’s largest insurers that would limit payment on anesthesia claims is prompting widespread outrage from lawmakers and physicians.
Anthem Blue Cross Blue Shield plans to “unilaterally” stop covering anesthesia claims for medical services and surgeries that last longer than an “arbitrary time limit,” according to the American Society of Anesthesiologists.
“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,” Dr. Donald E. Arnold, president of the group, said in a November statement from the group. “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.”
The policy change will take effect in Connecticut, New York, and Missouri, according to the group.
A note for Anthem providers in New York says the policy will take effect on February 1 in the state, and will base payment decisions on the Centers for Medicare and Medicaid Services’s (CMS) Physician Work Time values, formulas that help determine government payments to doctors.
“Claims with anesthesia services time exceeding the set limit will only pay up to the CMS established amount,” the provider note reads. Patients under 22 and those receiving maternity care are exempted.
Another provider note, reported by NPR, describes the same policy taking effect in Colorado, beginning in March.
The Independent has contacted Anthem for comment.
New York Governor Kathy Hochul called the policy “outrageous,” while Senator Chris Murphy of Connecticut branded it “appalling” in a post on X and warned it would result in “saddling patients with thousands of dollars in surprise additional medical debt.”
“And for what? Just to boost corporate profits?” he continued. “Reverse this decision immediately.”
Policy would limit anesthesia coverage for procedures that run over standard time limit (AFP via Getty Images)
Doctors, meanwhile, warned that the policy could impact care and doesn’t account for the many reasons a surgery or procedure might take longer than a pre-set formula.
“There are many real-world examples that I can provide as a medical doctor that illustrate how a predetermined time limit for anesthesiology coverage is not reasonable because there are many other medical factors at play,” Jeff Gordon, a Republican state senator and physician for Connecticut, wrote in a statement last month. “Each patient is different. Each surgery is different.”
The average price of anesthesia in outpatient visits rose 20 percent between 2018 and 2022, to $989, according to the Health Care Cost Institute.
The company has framed the measure as a way to actually reduce costs on patients by standardizing claims.
“We at Anthem strive to make health care simpler and more affordable,” the company told CNN. “One of the ways to achieve that goal is to help ensure that claims are accurately coded, and providers are reimbursed appropriately for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”
Eric Levitz, a correspondent at the progressive news outlet Vox, argues that there could be an upside to the policy change, noting in a post on X that “the alternative to capping pay rates to doctors who make $400,00+ a year is to have everyone pay higher premiums to support their extortionary billing.”
The heated public discussion around healthcare costs follows the Wednesday shooting of UnitedHealthcare CEO Brian Thompson outside a New York City hotel, in what police suspect was a targeted attack.