Anthem Blue Cross Blue Shield wanted to cap anesthesia coverage after a certain point, meaning such services after a set threshold would not be reimbursed.
That plan saw major blowback, with the American Society of Anesthesiologists in November calling for an immediate reversal.
“Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards,” the association cautioned. “With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem’s limit, Anthem will deny payment for the anesthesiologist’s care.”
Other groups, health care leaders and even elected officials similarly shared their concerns after Anthem’s coverage cap came out.
In somewhat of a surprising twist, Anthem will no longer move forward with its plans.
“There has been significant widespread misinformation about an update to our anesthesia policy,” Anthem Blue Cross Blue Shield told NPR on Thursday. “As a result, we have decided to not proceed with this policy change.”
Anthem’s cap on anesthesia care would have started in 2025.
In its original warning, the American Society of Anesthesiologists said the coverage cap would impact anesthesia payment under Anthem in three states: Connecticut, New York and Missouri. NPR reported Thursday, however, that a notice had likewise been sent to providers in Colorado.
Anthem’s original plan would have reportedly exempted maternity-related care and patients under the age of 22. It also provided a process for disputing claims if there was disagreement with a reimbursement decision.
Broadly, there is no established time limit for anesthesia during surgery or medical procedure, with services provided for however long they’re needed by the patient. Anthem, which is under the Elevance Health umbrella (NYSE: ELV), wanted to tie coverage to Physician Work Time values from the U.S. Centers for Medicare & Medicaid Services (CMS).
In a Friday statement, the American Society of Anesthesiologists said it is “pleased” that Anthem has reversed course on its “deeply flawed policy proposal.”
“These insurance policy decisions targeting anesthesiologists and anesthesia services provided to patients are not cost-saving solutions,” the association wrote. “Rather, they serve to shift costs from the insurers to hospitals, physicians and patients.”
The topic of anesthesia reimbursement policies is critically important to ambulatory surgery centers (ASCs) because it directly impacts their financial stability, operational efficiency and ability to deliver quality care.
And even prior to the coverage-cap drama, many ASC leaders viewed anesthesia as one of the strongest headwinds for the industry.
“Maintaining adequate anesthesia coverage is one of the top challenges facing many ASCs,” Joan Dentler, founder of Avanza Healthcare Strategies, told ASC News in August.
