Anthem Blue Cross Blue Shield said Thursday it was not going ahead with a policy change that would limit reimbursements for anesthesia during surgery and medical procedures. The new policy would have reimbursed doctors based on time limits set by the insurer.
Anthem BCBS, one of the largest health insurers in the U.S., quietly announced the new reimbursement policy last month for Connecticut, New York and Missouri beginning in February. The policy change triggered outrage from the American Society of Anesthesiologists.
Initially, the policy update went unnoticed, but that changed Wednesday after UnitedHealthcare CEO Brian Thompson was shot killed in New York City. The killing sparked a wave of online vitriol about the U.S. health care system, and Anthem BCBS’s decision roared into the conversation.
A spokesperson for Anthem BCBS said in a statement: “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 spokesperson added, "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.”
Before the reversal, New York and Connecticut had stepped in to stop the plan from going into effect.
On Thursday, New York Gov. Kathy Hochul took credit for pushing for the reversal. Hochul had expressed her indignation on X on Wednesday.
"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," Hochul said in a statement Thursday. "We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy."
On Thursday, Sean Scanlon, Connecticut’s comptroller, posted on X that the policy would no longer be going into effect in the state.
In an interview with NBC News, Scanlon said he didn't think the policy reversal was a direct correlation to the insurance executive's killing.
"I think these are two separate issues," Scanlon said.
He said the reversal was a win for people in Connecticut.
"I was really happy to see people speak up and use their voice, and I was happy to see Anthem reconsider their decision," he said.
Surgeons determine the timing of a procedure
Typically, there is no set time limit for anesthesia during surgery or a procedure. Anesthesia is administered for as long as a procedure takes — a decision determined by the doctor performing the procedure, rather than the anesthesiologist.
“The issue here is that the time, the length of surgery, is a function of the surgeon, not the anesthesiologist. The anesthesiologist is really at the mercy of the surgeon for however long they need to take to do the surgery well,” said Dr. Dhivya Srinivasa, the founder and chief surgeon at the Institute for Advanced Breast Reconstruction in Los Angeles.
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“In my arena, I’m a breast cancer reconstructive surgeon. There is a wide range of how long it will take based on complexity,” Srinivasa said.
The Anthem BCBS spokesperson said Wednesday afternoon the decision had been made to “safeguard against potential anesthesia provider overbilling” as part of the company’s “continuous efforts to improve affordability and accessibility to care.”
Anthem would be using the “CMS Physical Work Time values to determine the appropriate number of minutes” for procedures, the spokesperson said, referring to the Centers for Medicare and Medicaid Services.
Dr. Donald Arnold, the president of the American Society of Anesthesiologists, sharply questioned how Anthem had determined the time limits.
“No, it’s not part of Medicare or Medicaid,” he said. “Nobody else has a system like this.”
The CMS Physician Work Time values can be found on the CMS website.
“Medicare has some data,” Arnold said. “We don’t know the purpose of the data. We don’t know the provenance. We don’t know how it’s calculated. We don’t know any of that, except we can find the spreadsheet and we can download it. CMS hasn’t answered our questions so that we can understand how it was developed.”
On Friday, a CMS spokesperson said Medicare covers anesthesia without specific time limits and doesn’t limit payment for anesthesia services.
"CMS pays for anesthesia services in 15-minute increments with an additional fixed payment to account for the complexity of the procedure," the spokesperson said in a statement.
In January, Blue Cross Blue Shield of Massachusetts began restricting the use of anesthesia during colonoscopies but reversed its decision after pushback from doctors, including the American Gastroenterological Association.
