Anthem Abruptly Reverses Decision to Cap Anesthesia Coverage

Anthem Blue Cross Blue Shield (BCBS), one of the largest health insurers in the nation, abruptly reversed its recent decision to no longer link payments in certain states to the duration of a patient’s time under anesthesia.

The Reversal

Anthem BCBS attributed its reversal on Thursday to what it described as “significant widespread misinformation” surrounding the policy, according to a statement from the company.

“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.”

Under the proposed policy, Anthem BCBS planned to use “physician work time values” from the Centers for Medicare and Medicaid Services (CMS) to determine anesthesia time limits, excluding maternity patients and those under 22. However, Dr. Jonathan Gal, chair of the American Society for Anesthesiologists’ economics committee, noted that the methodology behind CMS’ calculation of those values remains unclear.

The Previous Policy

The previously proposed new policy would no longer reimburse anesthesia services for the complete duration of certain surgical procedures, opting instead for a partial coverage model, and the head of the ASA has called it “appalling” and “egregious,” creating a precarious situation for patients undergoing surgery.

In its previous announcement, Anthem BCBS said plans representing Connecticut, New York and Missouri have unilaterally declared they 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, reported the ASA, who has condemned the decision and called on Anthem to reverse this proposal immediately.

Backlash

The policy sparked a wave of concerns on social media with individuals across the country urging residents in affected states to contact their legislators. While many…