A policy change that will restrict reimbursements for anesthesia during surgery and other medical procedures was announced by Anthem Blue Cross Blue Shield on Thursday. Under the new arrangement, doctors would have received reimbursement according to deadlines that the insurance imposed.
The new payment policy for Connecticut, New York, and Missouri, which will take effect in February, was quietly disclosed last month by Anthem BCBS, one of the biggest health insurers in the United States. The American Society of Anesthesiologists expressed outrage about the policy change.
After UnitedHealthcare CEO Brian Thompson was shot dead in New York City on Wednesday, the policy change gained attention after first going unreported.Anthem BCBS’s decision erupted into the online hatred that the deaths aroused about the U.S. health care system.
An change to our anesthesia policy has been the subject of substantial and pervasive misinformation, according to a statement released by an Anthem BCBS spokeswoman. We have therefore chosen not to move further with this policy change.”
“To be clear, Anthem Blue Cross Blue Shield has never been and will never be the policy to not pay for medically necessary anesthesia services,” the representative continued. Only the appropriateness of anesthesia in accordance with existing clinical recommendations was intended to be clarified by the proposed policy modification.
New York and Connecticut had intervened to prevent the plan’s implementation prior to the reversal.
New York Governor Kathy Hochul claimed responsibility for the reversal on Thursday.Hochul had been outraged on Wednesday at Xon.
Hochul said in a statement Thursday, “Last night, I shared my outrage at a plan from Anthem to strip away coverage from New Yorkers who had to go under anesthesia for surgery.” “We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy.”
The comptroller of Connecticut, Sean Scanlon, said on X on Thursday that the policy would no longer be implemented in the state.
Scanlon stated in an interview with NBC News that he did not believe the policy reversal was directly related to the death of the insurance executive.
As Scanlon put it, “I think these are two separate issues,”
The reversal, he claimed, was a victory for Connecticut residents.
“I was really happy to see people speak up and use their voice, and I was happy to see Anthem reconsider their decision,” he stated.
Surgeons determine the timing of a procedure
Anesthesia for surgery or a procedure usually has no duration restriction. According to a choice made by the physician conducting the procedure, not the anesthesiologist, anesthesia is given as long as it takes.
The problem here is that the surgeon, not the anesthesiologist, determines the duration and timing of the procedure. According to Dr. Dhivya Srinivasa, the founder and chief surgeon of the Institute for Advanced Breast Reconstruction in Los Angeles, the anesthesiologist is truly at the mercy of the surgeon for however long it takes to do the procedure properly.
I work as a reconstructive surgeon for breast cancer. According to Srinivasa, the complexity will determine how long it takes.
As part of the company’s ongoing efforts to increase accessibility and affordability of treatment, Anthem BCBS announced Wednesday afternoon that the decision was made to protect against possible overbilling by anesthetic providers.
According to the representative, Anthem will use the Centers for Medicare and Medicaid Services’ Physical Work Time estimates to calculate how many minutes are needed for operations.
The American Society of Anesthesiologists’ president, Dr. Donald Arnold, raised serious concerns about Anthem’s methodology for setting the time restrictions.
“No,” he responded, “it’s not covered by Medicare or Medicaid.” This is the only system of its kind.
The CMS website has the CMS Physician Work Time figures.
According to Arnold, Medicare has some data. The purpose of the data is unknown to us. The provenance is unknown. We have no idea how it’s determined. Other than being able to locate and download the spreadsheet, we are unaware of any of that. In order for us to comprehend how it was created, CMS has not responded to our inquiries.
Medicare does not impose time limits on reimbursement for anesthetic procedures, according to a CMS representative on Friday.
“CMS pays for anesthesia services in 15-minute increments with an additional fixed payment to account for the complexity of the procedure,” the spokeswoman stated in a statement.
Blue Cross Blue Shield of Massachusetts started limiting the use of anesthesia during colonoscopies in January, but it later changed its mind in response to criticism from medical professionals, including the American Gastroenterological Association.
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