Anthem BCBS reverses course on anesthesia time limits
After announcing it would place time limits on reimbursement for the time a patient is under anesthesia, Anthem Blue Cross Blue Shield (BCBS) has backtracked on the policy, following outcry from providers and professional associations.
In a statement, Anthem BCBS denied it was ever going to implement such a policy, blaming reports on “significant widespread misinformation.” The insurer said it had intended to use “physician work time values” calculated using Centers for Medicare and Medicaid Services metrics to determine payouts. However, it appears to be backing down on the change outright.
“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 company said. “The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
The American Society of Anesthesiologists seemed to disagree about the outcome of the proposed change. In its own statement from November, the group said the insurer had “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.”
“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,” the group wrote.
Currently, payment for the use of anesthesia is billed based on the time it takes an anesthesiologist to do their work caring for patients before, during, and after an operation, including recovery time. The American Society of Anesthesiologists said Anthem BCBS’s policy would, instead, reimburse at a set value regardless of the actual length of surgery and recovery.
“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,” anesthesiologist Donald E. Arnold, MD, said in the statement from the American Society of Anesthesiologists.
“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. This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need,” he added.
It appears, for now at least, that the policy change is on hold, as Anthem BCBS has reversed course.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.