Anthem Blue Cross Blue Shield said Thursday it will not move forward with a policy change that would limit reimbursement for anesthesia during surgeries and medical procedures. The new policy would have reimbursed doctors based on time limits set by the insurance company.
Anthem BCBS, one of the largest health insurers in the United States, quietly announced a new reimbursement policy last month in Connecticut, New York and Missouri starting in February. The policy change angered the American Society of Anesthesiologists.
Initially, the policy update went unnoticed, but that changed on Wednesday, after the shooting of UnitedHealthcare CEO Brian Thompson in New York City. The murder sparked a wave of online vitriol about the U.S. health care system, and the Anthem BCBS decision came up in the conversation.
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In a statement to NBC News, an Anthem BCBS spokesperson said: “There has been significant and widespread misinformation surrounding our anesthesia policy update. As a result, we have decided not to move forward with this policy change.”
The spokesperson added: “To be clear, it has never been and will never be Anthem Blue Cross Blue Shield's policy not to pay for medically necessary anesthesia services. The proposed update to the policy is designed only to clarify the appropriateness of anesthesia consistent with established clinical guidelines.”
Before backing down, New York and Connecticut intervened to prevent the plan from taking effect.
On Thursday, New York Gov. Kathy Hochul took credit for pushing for the reversal. Hochul had expressed her dissatisfaction with X on Wednesday.
“Last night, I shared my outrage at Anthem’s plan to strip coverage from New Yorkers who had to undergo anesthesia for surgery,” Hochul said in a statement Thursday. “We pushed Anthem to reverse course and today they will announce a complete reversal of this misguided policy.”
On Thursday, Connecticut State Comptroller Sean Scanlon posted on X that the policy would no longer go into effect in the state.
“After hearing from people across the state about this troubling policy, my office has reached out to Anthem, and I am pleased to share with you that this policy will no longer go into effect here in Connecticut,” Scanlon wrote.
Usually, there is no set time limit for anesthesia during a surgery or procedure. Anesthesia is given for the duration of the procedure — a decision made by the doctor performing the procedure, not the anesthesiologist.
He said, “The problem here is that the time and duration of the surgery is the job of the surgeon, not the anesthesiologist. The anesthesiologist is actually at the mercy of the surgeon, no matter how long he needs to perform the surgery well.” Dr. Divya Srinivasa, founder and chief surgeon at the Advanced Breast Reconstruction Institute in Los Angeles.
“In my field, I'm a breast cancer reconstructive surgeon. There's a wide range of how long it will take based on the complexity,” Srinivasa said.
On Wednesday afternoon, an Anthem BCBS spokesperson said the decision was made “to protect against potential anesthesia provider overbilling” as part of the company’s “continued efforts to improve affordability and access to care.”
The insurer will use “CMS physical labor time values to determine the appropriate number of minutes” for procedures, the spokesperson said, referring to the Centers for Medicare and Medicaid Services.
Dr. Donald Arnold, president of the American Society of Anesthesiologists, sharply questioned how the insurance company sets time limits.
“No, it's not part of Medicare or Medicaid,” he said. “No one has a system like this.”
CMS physician work time 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 was calculated. We don't know any of that, except that we can find the spreadsheet and download it. The CMS didn't answer our questions so we could understand how it was developed. “
CMS did not immediately respond to a request for comment.
In January, Blue Cross Blue Shield of Massachusetts began restricting the use of anesthesia during colonoscopies, but reversed its decision after opposition from doctors, including the American Gastroenterology Association.
