On Nov. 1, Anthem Blue Cross Blue Shield announced changes to its anesthesia reimbursement policies in Connecticut, New York and Missouri that would place time limits on anesthesia care.
This move alarmed several physician specialists and industry groups, as anesthesia is necessary for all surgical procedures across all settings, including orthopedic and spine procedures.
After much backlash, the insurer walked back the policy proposal, which would have gone into effect in February, on Dec. 5.
Here are eight things to know about the proposal:
1. The changes would have affected claims under CPT codes 00100 through 01999. Anthem BCBS planned to use CMS physician work time values to identify the number of minutes reported for anesthesia services, and claims submitted with reported time over the set number of minutes would be denied.
2. The ASA called on Anthem BCBS to reverse this decision in a Nov. 14 statement shared with Becker's. ASA said that anesthesia care is individualized to each patient and that with this new policy, "Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure," in turn denying those physicians payment for "delivering safe and effective anesthesia care to patients … because their surgery is difficult, unusual or because a complication arises."
3. "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," said Donald Arnold, MD, president of 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."
4. Connecticut state senator Jeff Gordon, MD, addressed concerns over Anthem Blue Cross Blue Shield's new policy on anesthesia claims in a Nov. 20 letter. "I continue to press for answers to this significant, even detrimental, policy shift when it comes to patient care and outcomes," Dr. Gordon wrote. "As a medical doctor, I can provide many real-world examples that demonstrate how predetermined time limits for anesthesiology coverage are unreasonable. Each patient and surgery is unique. I will continue to advocate for patients and collaborate with my medical colleagues to address this situation." He also requested a joint meeting with the payer to discuss the policy.
5. The payer alleged that a walk-back on the policy was spurred by "widespread misinformation" surrounding the update.
6. Anthem faced scrutiny when posts about the policy went viral on X on Dec. 4, prompting policymakers to weigh in. The move sparked controversy when it was released, but outrage erupted following the murder of UnitedHealthcare CEO Brian Thompson, which shifted focus to insurance decisions.
7. "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," Anthem's statement continued. "The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."
8. This was one of many controversial policies proposed by the insurance company this year, which include a move that reduced QZ services performed by certified registered nurse anesthetists in Ohio, Missouri, Connecticut, New York, Nevada and Maine to 85% of the physician fee schedule.