Anthem Blue Cross Blue Shield aims to set limits on surgical anesthesia

Anthem Blue Cross Blue Shield aims to set limits on surgical anesthesia

One of the largest health insurers in the US will begin limiting the amount of time it covers for anesthesia while patients are under the knife – a shocking move that doctors are calling “unprecedented.”

Anthem Blue Cross Blue Shield — which represents policyholders in New York, Connecticut and Missouri — says starting in February it will deny claims where a patient was kept under anesthesia for longer than the designated time, depending on the procedure.


Doctors perform operations
Under Anthem Blue Cross Blue Shield’s new rules, patients will receive whatever amount of anesthesia the company deems appropriate. LICHTFIELD STUDIOS – stock.adobe.com

“We will use CMS physician work time values ​​to determine the number of minutes reported for anesthesia services. Applications whose reported time exceeds the specified number of minutes will be rejected,” the company wrote in a press release.

“This update will not change industry standard coding requirements or the American Society of Anesthesiologists (ASA) anesthesia formula,” Anthem claims.

The Nov. 1 announcement has sparked new interest following the assassination of UnitedHealthcare CEO Brian Thompson on Wednesday, as new evidence suggests the shooter may have been motivated by sentiment against the health insurance company.

The American Society of Anesthesiologists – a nearly 120-year-old organization representing 59,000 members – accused the insurance giant of putting “profits over patients” and immediately called on the insurance giant to change course.

“Anthem Blue Cross Blue Shield … has unilaterally stated that it will no longer pay for anesthesia care if the surgery or procedure exceeds an arbitrary deadline, regardless of how long the surgical procedure lasts,” the organization said in a press release.


Exterior view of Anthem headquarters
The American Society of Anesthesiologists called the move “appalling” and called on the insurer to reverse course. jetcityimage – stock.adobe.com

“With this new policy, Anthem will not pay anesthesiologists to provide safe and effective anesthesia care to patients who may require special attention because their surgery is difficult or unusual, or because a complication occurs.”

While medical services are typically billed per procedure or per appointment, anesthesiologists’ work is billed based on the exact length of time a patient is in their care, which is carefully calibrated based on their precise medical needs, the ASA emphasizes .

Finally, the organization notes that Anthem Health “reported a 24.12% year-over-year increase in its net income to $2.3 billion and a 24.29% year-over-year increase in its net profit margin.”

The only exclusions Anthem provides for its draconian new policy are for patients under the age of 22 or for anesthesia administered during maternity care.

Anthem did not immediately respond to a message from The Post seeking comment.

According to the company website, Anthem has nearly 6 million members in this space, including 4.8 million in New York and 1.1 million in Connecticut.

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