Anthem Insurance in Missouri limits anesthesia coverage after certain time limits

KANSAS CITY, Mo. (KCTV) – Anthem Insurance has decided to place time limits on anesthesia coverage, which was met with strong feedback from medical professionals.

The health insurance giant announced the move would take effect on February 1, 2025.

“We will use CMS physician work time values to determine the number of minutes reported for anesthesia services,” Anthem said in a November announcement. “Claims whose reported time is greater than the specified number of minutes will be rejected.”

The American Society of Anesthesiologists (ASA) opposed the move and called on the company to change course.

We wonder how Anthem could propose to only pay for a portion of the anesthesia services its customers need. The Directive does not provide that an anesthesia code can apply to very different surgical procedures with corresponding large differences in operating times. The policy also reveals that Anthem is less committed to patient choice and safety. If a patient’s surgery takes longer than Anthem accepts, Anthem effectively absolves itself of the responsibility to pay for the anesthesia required for the remainder of the procedure. Likewise, the guideline does not take into account the individual patient needs associated with the anesthesia period, including the management of surgical complications during the course of the procedure. Such complications are not included in the basic units allocated, but are billed and paid for under long-term payment arrangements that take time into account. The proposed Anthem policy reflects a significant disconnect between Anthem, its patients and their needs.

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Patients under 22 and maternity care are exempt from the change.

The ASA said it urges those concerned about Anthem’s proposal to contact their state insurance commissioner or state legislature.

According to ASA, the policy will go into effect for Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri.

Anthem stated that anyone who disagrees with a decision to reimburse a claim should follow the claim dispute process outlined in their provider’s manual and that documentation will be required to support such requests.

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Anthem Insurance in Missouri limits anesthesia coverage after certain time limits

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