Anthem Blue Cross Blue Shield announced Thursday that it will not move forward with policy changes that would limit reimbursement for anesthesia costs for surgeries and medical procedures. The new insurance would reimburse doctors based on deadlines set by the insurance company.
Anthem BCBS, one of the nation’s largest health insurers, quietly announced last month a new reimbursement policy for Connecticut, New York and Missouri starting in February. The policy change sparked outrage from the American Society of Anesthesiologists.
The policy update initially received little attention, but that changed Wednesday after UnitedHealthcare CEO Brian Thompson was shot in New York City. The killing sparked a wave of online outrage about the U.S. health care system, and Anthem BCBS’ decision added to the conversation.
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In a statement to NBC News, a spokesperson for Anthem BCBS said, “Significant misinformation regarding our updated anesthesia policy has been widely circulated. As a result, we have decided not to move forward with this policy change.” said.
The spokesperson continued, “To be clear, it has never been and will not be Anthem Blue Cross Blue Shield’s policy to not pay for medically necessary anesthesia services. The proposed update is intended solely to clarify the appropriateness of anesthesia along the following lines.” It is a well-established clinical guideline. ”
Prior to the reversal, New York and Connecticut had intervened to prevent the plan from being implemented.
On Thursday, New York Gov. Cathy Hochul took credit for pushing for the reversal. Hochul had expressed his anger towards X on Wednesday.
“Last night, I shared my anger at Anthem’s plan to strip coverage from New Yorkers who had to be put under anesthesia for surgery,” Hochul said in a statement Thursday. “We urged Anthem to change course, and today Anthem is announcing a complete reversal of this misguided policy.”
On Thursday, Connecticut State Comptroller Sean Scanlon posted on X that the policy would no longer be enforced in the state.
“After hearing about this policy from people across the state, my office reached out to Anthem and am happy to share that this policy will no longer be enforced here in Connecticut,” Scanlon wrote. Ta.
There is usually no set time limit for anesthesia during a surgery or procedure. Anesthesia is administered throughout the procedure, but the decision is made by the physician performing the procedure, not the anesthesiologist.
“The problem here is that determining how long or how long a surgery will take is the role of the surgeon, not the anesthesiologist. “We are at the mercy of the surgeon.” Dr. Divya Srinivasa, founder and chief surgeon of the Advanced Breast Reconstruction Institute in Los Angeles.
“In my field, I’m a breast reconstructive surgeon. Depending on the complexity, how long it takes varies,” Srinivasa said.
On Wednesday afternoon, a spokesperson for Anthem BCBS said that as part of the company’s “continuing efforts to improve affordability and access to care,” to “prevent potential anesthesia providers from overbilling.” said that this decision was taken.
The spokesperson said, referring to the Centers for Medicare and Medicaid Services, that insurers “use CMS physical labor time values to determine the appropriate number of minutes” for a procedure.
Dr. Donald Arnold, president of the American Society of Anesthesiologists, harshly questioned how insurance companies set the deadline.
“No, it’s not part of Medicare or Medicaid,” he said. “No one else has a system like this.”
CMS physician office hours values can be found on the CMS website.
“Medicare has some data,” Arnold said. “We don’t know what the data is for. We don’t know where it comes from. We don’t know how it’s calculated. We don’t know anything about it except that we can find and download spreadsheets. It doesn’t answer our questions to understand how it was developed.”
CMS did not respond to requests for comment.
In January, Blue Cross Blue Shield of Massachusetts began restricting the use of anesthesia during colonoscopies, but reversed the decision after opposition from doctors, including the American College of Gastroenterology.
