Anthem Blue Cross Blue Shield has announced it will no longer cover the full length of anesthesia during surgery if it exceeds a specific time limit, leading to outrage across social media, from average users to government officials.
The change will affect those receiving coverage in New York and Missouri, starting Feb. 1, 2025. Anthem Blue Cross Blue Shield also tried to implement the policy in Connecticut, but after pushback from the state’s comptroller’s office, it will no longer go into effect, Connecticut Comptroller Sean Scanlon posted on X on Thursday.
The announcement was made in early November but gained renewed attention following the fatal shooting of UnitedHealthcare CEO Brian Thompson, which prompted widespread criticism of the U.S. health care system.
For customers in Missouri and New York, next year, anesthesia coverage will be based on the CMS Physician Work Time values to “target the number of minutes reported for anesthesia services,” according to Anthem Blue Cross Blue Shield. (CMS stands for the Centers for Medicare and Medicaid Services.)
If a claim is submitted where the reported time for anesthesia services exceeds the established number of minutes, it will be denied, according to Anthem.
People under the age of 22 and maternity-related care will be excluded from the change, Anthem Blue Cross Blue Shield said.
For people who disagree with claim reimbursement decisions, Anthem said in its announcement that it’s possible to dispute claim denials using the process outlined in its provider manual.
“Documentation to support your request will be required,” the announcement stated.
A spokesperson for Anthem Blue Cross Blue Shield told NBC News in a statement that the intention behind the change is to “safeguard against potential anesthesia provider overbilling” in an effort “to improve affordability and accessibility to care.”
The American Society of Anesthesiologists said in a press release the move is “unprecedented” and based on “an arbitrary time limit.”
“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, resolving unexpected complications that may arise and/or extend the duration of the surgery, and working to ensure that the patient is comfortable during recovery.
“Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards.”
Dr. Donald E. Arnold, president of the society, added in a statement: “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,” Dr. Donald E. Arnold, president of the society, said in a 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,” Arnold continued. “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.”
The society called on the insurance company to reverse the proposal immediately.
Arnold further criticized the decision in an interview with NBC News. “Nobody else has a system like this,” he said, questioning the reliance on CMS time limits.
“We don’t know how it’s calculated. We don’t know any of that, except we can find the spreadsheet and we can download it. CMS hasn’t answered our questions so that we can understand how it was developed,” he said.
CMS did not immediately respond to NBC News’ request for comment.
Government leaders across New York and Connecticut responded to the news in early December.
“Outrageous. I’m going to make sure New Yorkers are protected,” New York Gov. Kathy Hochul wrote in a post on X.
Sen. Chris Murphy from Connecticut also weighed in.
“This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits? Reverse this decision immediately,” Murphy said in a post on X.
Other social media users joked about the change.
“BYOA: Bring your own anesthesia,” one X user posted.
“Well no, you’ll take the anesthesia, of course. They just get to keep your house afterwards,” another X user commented.
“So it begins. America healthcare is about to become the hunger games,” an X user wrote.
First appeared on www.today.com