Insurer Reverses Course on Controversial Policy After Widespread Criticism

Surgeons performing a surgery in an operating room.

Anthem Blue Cross Blue Shield reverses course on a controversial anesthesia reimbursement policy after facing intense backlash from medical professionals and government officials.

At a Glance

Anthem BCBS abandoned a proposed policy that would limit anesthesia reimbursements based on time
The policy would have affected Connecticut, New York, and Missouri starting February 2025
Medical professionals and government officials strongly opposed the change
Anthem cited “significant widespread misinformation” as a reason for not proceeding

Anthem’s Controversial Policy Reversal

In a surprising turn of events, Anthem Blue Cross Blue Shield has decided to abandon its proposed changes to anesthesia reimbursement policies. The insurance giant had planned to implement time-based limits on reimbursements for anesthesia during surgeries and medical procedures in Connecticut, New York, and Missouri starting February 2025. This move sparked outrage among medical professionals, particularly the American Society of Anesthesiologists (ASA), who argued that such limitations could lead to underpayment and compromise patient care.

The proposed policy would have capped anesthesia coverage based on pre-set time limits, potentially leaving patients uncovered if procedures ran longer than expected. Critics argued that anesthesia time should be determined by surgeons and medical necessity, not insurers. The ASA and other stakeholders criticized the move, calling it a profit-driven decision that could undermine quality care.

Government Intervention and Public Pressure

The controversy quickly drew the attention of government officials. New York Governor Kathy Hochul and Connecticut’s Comptroller Sean Scanlon intervened, leading to the policy reversal. Their swift action highlighted the significance of the issue and the potential impact on patient care.

“We pushed Anthem to reverse course, and today they will be announcing a full reversal of this misguided policy.” – New York Governor Kathy Hochul

The backlash wasn’t limited to government officials. Medical professionals and the public voiced their concerns about the potential risks to patient safety and the quality of care. This widespread opposition played a crucial role in Anthem’s decision to abandon the policy.

Anthem’s Response and Clarification

In response to the outcry, Anthem BCBS cited “significant widespread misinformation” as a reason for not proceeding with the policy. The company emphasized that it never intended to deny reimbursement for medically necessary anesthesia services.

“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change. 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. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.” – Anthem

Anthem claimed that the policy was misunderstood and was meant to clarify anesthesia appropriateness based on clinical guidelines. The company stated that the proposed update was designed to align with these guidelines and prevent potential overbilling by anesthesia providers.

Implications for the Healthcare Industry

This incident has sparked broader discussions about healthcare reimbursement strategies and the balance between cost-saving measures and quality patient care. The ASA expressed concerns about the use of Medicare data for non-Medicare patients and the potential financial strain from Medicare payment cuts.

“They’re using some Medicare information that was not designed to be used for payment considerations and applying it to the non Medicare patient population.” – Arnold

The controversy has also led to calls for legislative action. New York State Senate Deputy Majority Leader Michael Gianaris plans to introduce legislation to prevent similar policies in the future, highlighting the ongoing tension between insurance companies and healthcare providers.

As the dust settles on this controversy, it serves as a reminder of the complex interplay between healthcare costs, quality of care, and the role of insurance companies in determining medical practices. The swift reversal of Anthem’s policy underscores the power of collective action and the importance of vigilance in protecting patient care standards.