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A new policy from one of the nation’s largest insurers that would limit payments for anesthesia claims has sparked widespread outrage from lawmakers and doctors.
Anthem Blue Cross Blue Shield plans to “unilaterally” stop covering anesthesia claims for medical services and surgeries that last longer than an “arbitrary time limit,” according to the American Society of Anesthesiologists.
“This is just the latest in a long line of appalling behavior by commercial health insurers seeking to increase their profits at the expense of patients and primary care physicians,” Dr. Donald E. Arnold, the group’s president, he said in the group’s November statement. “It’s a cynical cash grab by Anthem, designed to take advantage of the commitment that anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care.”
The policy change will take effect in Connecticut, New York and Missouri, according to the group.
A note for providers Anthem in New York says the policy will go into effect Feb. 1 in the state and will base payment decisions on Centers for Medicare and Medicaid Services (CMS) physician hours values, formulas that help determine state payments to doctors .
“Timed claims for anesthesia services that exceed the set limit will be paid only up to the amount determined by CMS,” the provider note said. Patients under the age of 22 and those receiving maternity care are exempt.
Another vendor note, reported by NPR, describes the same policy taking effect in Colorado, starting in March.
The Independent has contacted Anthem for comment.
New York Governor Kathy Hochul called the policy “unheard of”, while Senator Chris Murphy from Connecticut called it “appalling”. fast on X and warned that it would result in “burdening patients with thousands of dollars in surprise medical debt.”
“And for what? Just to increase corporate profits?” he continued. “Reverse this decision immediately.”
Doctors, meanwhile, warned that the policy could affect care and does not take into account the many reasons a surgery or procedure could take longer than the preset formula.
“There are many real-world examples that I can provide as a physician that illustrate how a predetermined time limit for anesthesiology coverage is not reasonable because there are many other medical factors at play,” Jeff Gordon, Republican state senator and physician for Connecticut, wrote in a statement last month. “Every patient is different. Every operation is different.”
The average cost of anesthesia in outpatient visits increased by 20 percent between 2018 and 2022, to $989, according to the Institute for Health Care Costs.
The company framed the measure as a way to actually reduce patient costs by standardizing claims.
“At Anthem, we strive to make healthcare simpler and more affordable,” the company said CNN. “One way to achieve that goal is to ensure that claims are accurately coded, and that providers are compensated appropriately for the services they provide to members. Incorrect coding leads to higher health care costs than they would otherwise be.”
Eric Levitz, a correspondent for the progressive news outlet Vox, argues that the policy change could be a good thing, noting in the fast on X that “the alternative to capping the salaries of doctors making more than $400.00 a year is to have them all pay higher premiums to support their extortionate bills.”
A heated public debate over health care costs follows on Wednesday shooting of UnitedHealthcare CEO Brian Thompson outside a hotel in New York, in what police suspect was a targeted attack.