Doctors and policymakers are sounding the alarm after one of the nation’s largest health insurers announced that starting next year it will no longer cover the cost of anesthesia treatments in certain states if the surgery or procedure exceeds a certain deadline.

Anthem Blue Cross Blue Shield says that starting in February, it will use metrics — called Physician Work Time scores — from the Centers for Medicare and Medicaid Services (CMS) to “determine the number of minutes reported for anesthesia services.”

“Applications with reported time exceeding the specified number of minutes will only be paid up to the amount determined by CMS,” said a notice to New York providers earlier this week.

It’s not clear which states will roll out the policy first. The American Society of Anesthesiologists (ASA) says the move will take effect in Connecticut, New York and Missouri. And it appears a similar notice was also issued to providers in Colorado, with a start date of March.

NPR has reached out to Anthem for more information.

Anthem says maternity care and patients under 22 will be exempt from the tax and that providers can follow a claim dispute process if they disagree with a reimbursement decision.

Still, there has been intense backlash to the announcement, which has only increased this week, particularly after the fatal shooting of another health insurance company’s CEO sent social media into a frenzy and brought the industry even more into the spotlight.

The announcement sparked a trail of anger and fear on social media. Users joked about being woken up in the middle of surgery and worried that their doctors would have to rush the procedure. But others say that standardizing anesthesiologists’ pay to a fixed rate is actually beneficial for patients who might otherwise be overpaid – and that’s exactly the argument Anthem makes.

Anesthesiologists accuse Anthem of putting profits over patients

In mid-November, the ASA released a statement calling the policy a “cynical money grab” and calling on Anthem to immediately reverse it.

“This outrageous policy breaks the trust between Anthem and its policyholders, who expect their health insurance to pay doctors for all the care they need,” said ASA President Dr. Donald Arnold.

Payment for anesthesia services depends on several factors, the company said, including the exact amount of time anesthesiologists need to provide care before, during and immediately after surgery.

The ASA says that by “arbitrarily” setting the time allotted for anesthesia care during a procedure, Anthem “will not pay anesthesiologists to provide care to patients who may require special attention because their operation is difficult or unusual.” because a complication occurs, provide safe and effective care.” .”

This would require patients to cover out-of-pocket costs, which could range from hundreds to thousands of dollars.

“This is just the latest in a long line of appalling behavior by commercial health insurers seeking to increase their profits at the expense of patients and physicians who provide primary care,” Arnold said.

The ASA noted that Anthem – which has been renamed Elevance Health in recent years – reported a 24.12% year-on-year increase in its net profit to $2.3 billion in June.

Anthem did not respond to NPR’s request for comment. But in a statement to FOX61 of Connecticut, the company called its decision a way to “protect itself from possible overbilling by anesthesia providers.”

“Anthem is committed to helping make healthcare easier and more affordable,” it said. “One way to achieve this goal is to ensure that claims are accurately coded and providers are appropriately compensated for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”

Elected officials are getting involved

The ASA encourages people concerned about the policy change to contact their state insurance commissioner or legislators.

And as news of Anthem’s announcement spread on social media this week, elected officials in some affected states called for action.

New York Gov. Kathy Hochul called the decision “outrageous” and said she would “ensure New Yorkers are protected,” but did not specify how.

“Does Anthem expect a patient to get up and walk away in the middle of an operation?” New York State Senator Mike Gianaris tweeted on Wednesday. “I will introduce legislation to ban this practice and protect patients who need care.”

Sen. Chris Murphy, D-Conn., publicly called on Anthem to immediately reverse course.

“This is horrific. Saddling patients with thousands of dollars in additional medical debt,” Murphy tweeted. “And for what? Just to increase corporate profits?”

Republican Sen. Jeff Gordon of Connecticut — a practicing oncologist and hematologist — sent a letter to Connecticut Anthem Blue Cross and Blue Shield last month urging them to reverse the decision, saying: “The health care and lives of the People depend on it.”

In the letter, Gordon requested more information about the company’s reasons for setting a deadline, including whether it is supported by research or data.

“This policy is inconsistent with providing good, safe medical care to people in Connecticut and other states,” he wrote. “It could lead to preventable adverse events and/or unnecessarily poor outcomes. Why would Anthem BCBS have such a policy?”

Gordon reiterated that there are many reasons why a surgery or procedure can take longer than planned, including unexpected challenges.

For example, if a woman undergoes a hysterectomy for fibroid bleeding and the surgeon decides to extend the operation time to control the bleeding, the surgeon and anesthesiologist would have to decide whether to stop based on Anthem’s guidelines or to continue treating the patient cover additional costs, “potentially leading to crippling medical debt.”

Anthem’s limit on anesthesia coverage “disregards these real medical circumstances,” he added, urging the company to “do the right thing.”