...
By Emma Marsden
Reporter
0
Share
Newsweek is a Trust Project member
See more of our trusted coverage when you search.Prefer Newsweek on Googleto see more of our trusted coverage when you search.
A recent policy change by health insurer Anthem Blue Cross Blue Shield (BCBS) has led to sharp criticism from the American Society of Anesthesiologists (ASA), who warn that the decision could jeopardize patient safety and increase financial strain on both patients and providers.
The proposed new policy will 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.
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.
Read More on U.S.
The organization, which represents over 59,000 anesthesiologists nationwide, expressed concern that the change will undermine the continuity of care provided by anesthesiologists during surgery.
"With this new policy, Anthem will arbitrarily predetermine the time allowed for anesthesia care during a surgery or procedure," said ASA.
"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," it added.
In a strongly worded open letter last month to Elevance Health Inc., the corporate name for Anthem, Dr. Donald E. Arnold, president of the ASA, said the proposed policy was "inappropriate and misguided."
"On behalf of the 58,000 members of the American Society of Anesthesiologists (ASA), I write to express our grave concern about the announced Anthem policy to disregard well-established anesthesia time billing standards in Connecticut, Missouri, and New York," Dr. Arnold wrote.
"The Anthem policy provides no justification for paying for anesthesia services for only a portion of a patient's surgery. We request an immediate meeting with the Anthem officials who have authority over, and who will hold accountability for, this proposed policy change."
Dr. Arnold concluded the letter by saying: "We question how Anthem could propose paying for only a portion of the anesthesia service needed by their customers. The policy does not contemplate that an anesthesia code may apply to vastly different surgical procedures with corresponding wide variations in surgical times.
"The policy also betrays a diminished dedication to patient agency and safety on the part of Anthem. In effect, if a patient has a surgery which lasts longer than the standards accepted by Anthem, Anthem has absolved themselves of responsibility to pay for the anesthesia that is needed for the rest of the encounter.
"Likewise, the policy does not contemplate individual patient needs which are embedded within anesthesia time, including treatment of surgical complications during the course of the procedure. Such complications are not incorporated into the allocated base units but are accounted and paid for under long-standing payment regulations which incorporate time.
"The proposed Anthem policy reflects a significant disconnect between Anthem, its patients, and their needs," Dr. Arnold added.
...
He said the policy creates a precarious situation for patients undergoing surgery, calling the policy "appalling" and "egregious."
"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," he said, as reported by the ASA.
"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."
ASA urges people concerned about Anthem's proposal to contact their state insurance commissioner or their state legislator.
In an emailed statement to Newsweek on Thursday afternoon, Elevance Health said: "There has been significant widespread misinformation about an update to our anesthesia policy.
"As a result, we have decided to not proceed with this policy change. 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 proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."
ASA Responds to Anthem's Policy Reversal
In response to Anthem's reversal, ASA issued a statement on Friday which was forwarded to Newsweek and said in part: "The American Society of Anesthesiologists (ASA) is pleased that Anthem has reversed course on its deeply flawed policy proposal to no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary, Anthem-set time limit, regardless of how long the surgical procedure actually takes.
"Anthem was set to implement this policy on Feb. 1, 2025, in Connecticut, New York and Missouri. ASA and other surgical safety advocates were instrumental in notifying the public, patients and health care colleagues of Anthem's proposed policy on physician payment and strongly called for its reversal. The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of Anthem.
"Anesthesiologists provide individualized care to every patient, carefully assessing the patient's health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, ensuring their safety, resolving unexpected complications that may arise and/or extend the duration of the surgery and working to ensure the patient is comfortable during recovery.
"ASA expects the decision by Anthem to reverse its misguided policy will be permanent. ASA welcomes Anthem's decision but notes that Anthem's recent policy proposal reflects a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms that recognize anesthesia services and care, especially for care provided in emergency situations, to patients of extreme age and for more complex and vulnerable patients who require additional care from an anesthesiologist."
Update 12/5/24, 5:37 p.m.: This article was updated with comment from Elevance Health.
Update 12/6/24 3:33 p.m.: This article was updated with a statement from ASA in response to Anthem's policy reversal.
View 0 Comments
Submit Correction
View Editorial & AI Guidelines