Insurer Anthem Blue Cross Blue Shield said Thursday it was not moving forward with a policy change that would limit reimbursements for anesthesia during surgeries 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 United States, quietly announced last month the new reimbursement policy for Connecticut, New York and Missouri starting in February. The change sparked outrage from the American Society of Anesthesiologists.
In a statement to NBC News, an Anthem BCBS spokesperson said: “There has been significant widespread misinformation regarding an update to our anesthesia policy. As a result, we have decided not to proceed with this policy change.”
The spokesperson added: “To be clear, it has never been nor will it be the policy of Anthem Blue Cross Blue Shield not to pay for medically necessary anesthesia services. “The proposed policy update was only intended to clarify the appropriateness of anesthesia based on well-established clinical guidelines.”
Before the repeal, New York and Connecticut had intervened to prevent the plan from taking effect.
On Thursday, New York Gov. Kathy Hochul took credit for pushing for the repeal. On Wednesday, Hochul had expressed his indignation on the social network X.
“Last night I shared my outrage over Anthem’s plan to drop coverage for New Yorkers who had to undergo surgery under anesthesia,” Hochul said in a statement Thursday. “We pressured Anthem to reverse course and today they will announce a complete reversal of this misguided policy.”
On Thursday, Connecticut Comptroller Sean Scanlon posted on X that the policy would no longer take effect in the state.
“After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I am pleased to share this policy will no longer be in effect here in Connecticut,” Scanlon wrote.
There is usually no set time limit for anesthesia during an operation or surgical procedure. Anesthesia is administered for the duration of the procedure, a decision determined by the doctor performing the procedure, instead of the anesthesiologist.
“The point is that the time, the duration of the intervention, depends on the surgeon, not the anesthetist. The anesthetist is at the mercy of the surgeon in terms of the time he needs to do the operation well,” says Dhivya Srinivasa, founder and surgeon-in-chief of the Advanced Breast Reconstruction Institute in Los Angeles.
“In my field, I am a breast cancer reconstructive surgeon. There is a wide range of times depending on the complexity,” Srinivasa said.
On Wednesday afternoon, an Anthem BCBS spokesperson said the decision had been made to “safeguard against potential overbilling of anesthesia providers” as part of the company’s “ongoing efforts to improve affordability and accessibility to care.” attention”.
The insurance company will use “CMS physical work time values to determine the appropriate number of minutes” for the procedures, the spokesperson said, referring to the Centers for Medicare and Medicaid Services.
Donald Arnold, president of the American Society of Anesthesiologists, sharply questioned how the insurer had determined the time limits.
“No, it’s not part of Medicare or Medicaid,” he said. “No one else has a system like that.”
CMS physician work time values can be found on the CMS website.
“Medicare has some data,” Arnold said. “We do not know the purpose of the data. We do not know its origin. We don’t know how they are calculated. We don’t know anything about that except that we can find the spreadsheet and download it. “CMS has not responded to our questions so we can understand how it played out.”
CMS did not immediately respond to a request for comment.
