Insurer Anthem Rescinds Anesthesia Policy Change After Backlash

Follow Drugslib on

Medically reviewed by Carmen Pope, BPharm. Last updated on Dec 6, 2024.

By Robin Foster HealthDay Reporter

FRIDAY, Dec. 5, 2024 -- 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.

Sources

  • Anthem Blue Cross Blue Shield, statement, Dec. 5, 2024
  • NBC News

    • Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

    Source: HealthDay

    Posted : 2024-12-07 00:00

    Read more

    Disclaimer

    Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

    The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

    Popular Keywords