By Robin Foster HealthDay Reporter
FRIDAY, Dec. 6, 2024 (HealthDay News) — After facing weeks of pushback, health insurer Anthem Blue Cross Blue Shield said Thursday it will not go ahead with a policy change that would have limited reimbursements for anesthesia during medical procedures.
If the proposed policy had taken effect, it would have only reimbursed doctors based on time limits set by the insurer.
When the change was first announced last month, the American Society of Anesthesiologists (ASA) quickly responded with outrage.
“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,” the society said in a statement at the time. “The American Society of Anesthesiologists calls on Anthem to reverse this proposal immediately.”
“With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure,” the society added. “If an anesthesiologist submits a bill where the actual time of care is longer than Anthem’s limit, Anthem will deny payment for the anesthesiologist’s care. 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.”
ASA President Dr. Donald Arnold went further in criticizing the proposed policy change.
“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,” Arnold said in the statement. “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.”
In a statement posted Thursday, Anthem explained why it decided to try to implement, and then ultimately shelve, the proposal.
“The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines,” the insurer said in the statement. “Any medically necessary anesthesia would have been paid under the update. In circumstances when anesthesia providers went outside of well-established clinical guidelines, they would have been able to submit medical documentation to support accurate payment.”
However, “based on feedback received and misinterpretation of our policy change, it is evident that our communication regarding this policy was not clear, and as a result, we have decided to not proceed with this policy change,” Anthem added.
Typically, there is no set time limit for anesthesia during surgery or a medical procedure. Anesthesia is administered for as long as a procedure takes — a decision determined by the doctor performing the procedure, rather than the anesthesiologist.
“The issue here is that the time, the length of surgery, is a function of the surgeon, not the anesthesiologist. The anesthesiologist is really at the mercy of the surgeon for however long they need to take to do the surgery well,” Dr. Dhivya Srinivasa, founder and chief surgeon at the Institute for Advanced Breast Reconstruction in Los Angeles, told NBC News.
“In my arena, I’m a breast cancer reconstructive surgeon. There is a wide range of how long it will take, based on complexity,” Srinivasa added.
In January, Blue Cross Blue Shield of Massachusetts began restricting the use of anesthesia during colonoscopies but reversed its decision after pushback from doctors.
More information
The Cleveland Clinic has more on anesthesia.
SOURCES: Anthem Blue Cross Blue Shield, statement, Dec. 5, 2024; NBC News
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