Anthem BCBS Cancels Controversial Planned Anesthesia Payment Change

Anthem Blue Cross and Blue Shield has reversed course on its plan to change the way it reimburses for anesthesia care payments, which critics said included not paying for anesthesia care for the entirety of cases that went beyond a pre-set time limit.

Anthem, one of the largest commercial health insurance companies in the U.S., announced in mid-November that it was updating its policy on how it evaluates the time billed by anesthesiologists. The proposal drew immediate outcry from patients and medical professionals. Anthem announced it was not proceeding with the change on Dec. 5.

“There has been significant widespread misinformation about an update to our anesthesia policy,” says a company statement. “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 has said the proposal was essentially a move to prevent overbilling by anesthesiologists. Doing so, the company says, would prevent patients from being overcharged and would allow the company to provide more affordable care across its system. Critics, meanwhile, say the move would have shouldered patients with large out—of-pocket costs for the portion of the cases for which anesthesia care would have been denied.

“The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. Any medically necessary anesthesia would have been paid under the update,” says the Anthem statement. “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.”

The American Society of Anesthesiologists (ASA) led the charge in opposing the proposal, saying it was “deeply flawed” and would the proposed time limits that would have been paid for were “arbitrary” and “Anthem-set.”

ASA says the policy would have gone into effect Feb. 1 in New York, Connecticut and Missouri. “The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of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,” says a Dec. 6 ASA statement.

While ASA said it welcomes Anthem’s reversal, it says, “the 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.” OSM