Anthem Blue Cross Blue Shield announced it would no longer proceed with a proposed policy change that aimed to limit the duration of anesthesia coverage for surgeries and procedures.
The decision followed significant criticism from anesthesiologists and professional medical organizations.
“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,” the company said.
“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.”
The initial plan, which was to take effect in February, would have allowed Anthem to deny claims for anesthesia services exceeding specific time limits set for procedures, a report from CNN said. The policy would have applied to plans in Connecticut, New York, and Missouri, with exclusions for maternity-related care and pediatric patients under 22.
Anthem said the proposed change was part of a broader effort to reduce healthcare costs by addressing overbilling for anesthesia.
However, the American Society of Anesthesiologists (ASA) and other groups expressed concerns, stating that the policy reflected a misunderstanding of the complexities of anesthesia care.
The ASA called for a reversal of the policy, describing it as uninformed. The group emphasized that anesthesiologists provide individualized care based on a patient’s health, medical conditions, and the procedure’s requirements. They also noted that unexpected complications during surgery often necessitate additional anesthesia time.
Dr Gordon Morewood, vice chair for the ASA’s Committee on Economics, participated in discussions with Anthem executives to address these concerns. He said anesthesiologists explained that one billing code could encompass nearly 200 different procedures, leading to significant variability in anesthesia duration.
Morewood added that Anthem had not audited claims or provided evidence of overbilling.
“It’s a cynical exercise in figuring out a way to reject more claims initially, knowing that a number of those are just going to fall off and never be paid,” Morewood said.
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