Key Takeaways:

• Anthem Blue Cross Blue Shield reversed a policy linking payments to the length of a patient’s anesthesia after public backlash, citing “significant misinformation” about the policy.
• The company stated it will continue covering all medically necessary anesthesia services and clarified that the update aimed to align with clinical guidelines.
• Anthem members in Connecticut, Missouri, and New York are encouraged to stay informed and prepare for potential impacts on surgical procedures exceeding the new coverage limits.

UPDATE:

Anthem Blue Cross Blue Shield reversed a policy change after public backlash, deciding not to link payments to the duration of a patient’s anesthesia. The company cited “significant misinformation” about the policy as the reason for its reversal.

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“To be clear, we never have and never will refuse to cover medically necessary anesthesia services,” the statement said. “The proposed update was only meant to clarify when anesthesia is appropriate, based on well-established clinical guidelines.”

Under this new directive, Anthem will use the CMS Physician Work Time values to decide the allowable minutes for anesthesia services covered under their plans. Anthem will outright deny any claim for anesthesia time exceeding these limits. This approach is a departure from previous practices where the duration of anesthesia coverage was based on the actual length of a surgery or procedure.

However, there are exceptions to this rule. Anthem specifies that patients under 22 years old and those receiving maternity-related care will not be subject to this change. The company asserts that policyholders possess the entitlement to contest claims they perceive as unjustly reimbursed.

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The American Society of Anesthesiologists has openly criticized Anthem’s policy change, arguing it compromises patient safety by potentially discouraging necessary prolonged care during complicated or unexpected surgical circumstances. They advise affected patients to seek intervention from state insurance commissioners or legislators.

Public officials have also voiced their disapproval. Senator Chris Murphy expressed his dismay on social media, condemning the move as a means to increase corporate profits at the expense of saddling patients with unforeseen medical debt. Similarly, New York Governor Kathy Hochul promised action to protect residents from what she termed as an “outrageous” policy shift.

As news spreads, Anthem Blue Cross Blue Shield customers in Connecticut, Missouri, and New York are advised to closely monitor developments and consider their options should they need surgical procedures in the future that could extend beyond Anthem’s newly established anesthesia coverage limits.

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