Anthem Blue Cross Blue Shield has abandoned it’s controversial plan to limit coverage for anesthesia during surgeries and procedures following a wave of criticism from anesthesiologists.
The insurance giant announced on Thursday that it would no longer proceed with the policy change, citing “significant widespread misinformation” about the update. “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” the company stated.
Anthem had initially planned to implement the change in February, denying claims for anesthesia services that exceeded specific time limits for various surgeries and procedures. The company argued that the move was intended to make healthcare more affordable by curbing overbilling for anesthesia.
“The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines,” Anthem added in its statement.
However, the American Society of Anesthesiologists (ASA) strongly opposed the policy change, labeling it an “unprecedented move” and calling it “egregious and uninformed.”
“Anesthesiologists are highly trained medical specialists who provide essential care to patients undergoing surgery and other procedures,” the ASA said in a statement. “Limiting coverage for anesthesia services would jeopardize patient safety and access to quality care.”
The ASA’s strong rebuke, coupled with concerns raised by other medical professionals and patient advocacy groups, ultimately led Anthem to reverse its decision.
In a victory for patient care and medical professionals,Anthem Blue Cross Blue Shield has reversed its controversial policy that would have limited payments for anesthesia services during surgical procedures. The decision comes after widespread criticism from anesthesiologists and medical organizations who argued the policy was based on a misunderstanding of surgical complexities and would have negatively impacted patient safety.
The American Society of Anesthesiologists (ASA) had strongly opposed anthem’s initial plan, emphasizing the individualized nature of anesthesia care. “anesthesiologists provide individualized care to every patient, carefully assessing the patient’s health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, resolving unexpected complications that may arise and/or extend the duration of the surgery, and working to ensure that the patient is agreeable during recovery,” the ASA stated in a press release.
Anthem had initially defended its policy, claiming it aligned with industry standards and formulas set by the ASA. However, the ASA refuted this claim, highlighting the vast variability in surgical procedures and the inadequacy of using a single billing code to determine anesthesia time.
Dr.Gordon Morewood, vice chair for the ASA’s Committee on Economics, participated in meetings with Anthem executives, attempting to clarify the complexities of anesthesia billing.”Experts tried to explain the way anesthesia billing works — that one specific billing code could be used for nearly 200 different procedures, leaving grate variability in the amount of time needed under anesthesia — and learned that Anthem hadn’t audited claims and didn’t have any evidence that there was a problem that needed to be fixed,” Dr. Morewood explained.
Dr. Morewood expressed concern that Anthem’s policy was primarily driven by a desire to reduce costs rather than improve patient care. “It’s a cynical exercise in figuring out a way to reject more claims initially, knowing that a number of those are just going to fall off and never be paid,” he said.
The reversal of Anthem’s policy is a significant win for patients and the medical community. It underscores the importance of evidence-based decision-making in healthcare and the need for open interaction between insurers and medical professionals.
A major health insurer’s new policy is raising concerns among anesthesiologists who say it could jeopardize patient safety and erode trust in the medical system. Anthem Blue Cross Blue Shield recently announced it will no longer fully reimburse anesthesiologists for time spent caring for patients beyond a predetermined limit during surgery.
The policy, which has already been implemented in some states, has sparked outrage among medical professionals who argue that it fails to account for the complexities of anesthesia care. they say that unforeseen circumstances during surgery, such as complications or changes in a patient’s condition, frequently enough require anesthesiologists to extend their time in the operating room.
“any additional time under anesthesia is usually related to ensuring that patients are safely cared for, such as securing a safe airway, or responding to physiologic changes that may occur because of the surgery, such as blood pressure or respiratory changes,” said Dr. Rick van Pelt, a board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital.
Dr. van Pelt expressed deep concern about the potential consequences of Anthem’s policy. “This approach reflects a profound lack of understanding of the role of the anesthesiologist in providing safe,high-quality care to patients as an integral member of the surgical care team,” he said. “While no anesthesiologist would intentionally compromise on the care they provide, it is inevitable that unwarranted time pressure will increase the risk of adverse medical events and patient harm.”
Dr. David Morewood,president of the American Society of Anesthesiologists,echoed these concerns. He emphasized the importance of trust between patients and their anesthesiologists, particularly in the vulnerable setting of surgery. “Anesthesiology is often a top fear for surgical patients and adding uncertainty around insurance coverage threatens trust in a vulnerable moment,” said Dr. Morewood, who is also chair and professor of clinical anesthesiology at Temple University’s Lewis Katz School of Medicine.
Dr. Morewood highlighted the potential for this policy to create additional stress for both patients and medical professionals. “Oftentimes you’re meeting your anesthesiologist on the day of surgery. And yet, this is someone in whom you are literally putting your life in their hands. They are responsible for your continued existence on this planet an hour, two hours, six hours from now. So that’s a very charged environment,” he said. “To have insurance companies saying, ‘Okay, the metre is going to run out after an hour and a half’ is just unconscionable.”
## World Today News: Expert Interview – Anthem Backs Down on Controversial Anesthesia Policy
**World Today News:** Anthem Blue Cross Blue Shield’s decision to reverse its controversial policy on anesthesia coverage has sent ripples through the medical community. To understand the implications of this decision, we spoke with Dr. Gordon Morewood, Vice Chair for the American Society of Anesthesiologists’ Committee on Economics, who played a key role in challenging Anthem’s initial plan.
**WTN:** Dr. Morewood, thank you for joining us today. Can you elaborate on the initial policy proposed by Anthem and why it raised such strong opposition from the ASA?
**Dr. Morewood:** The proposed policy would have limited reimbursement for anesthesia services based on predetermined time limits for various surgeries. The ASA, along with other medical professionals, vehemently opposed this because it fundamentally misunderstood the complexities of anesthesia care.
anesthesia isn’t a one-size-fits-all service.It requires individualized care depending on the patient’s medical history, the complexity of the surgery, and the potential for complications. A single billing code can encompass nearly 200 different procedures, each with varying anesthesia needs. Anthem’s policy disregarded this variability and risked compromising patient safety.
**WTN:** Anthem defended its policy, citing industry standards and formulas aligned with the ASA. How did the ASA respond to these claims?
**Dr. Morewood:** Anthem’s claims were misleading. While there are guidelines for anesthesia care, they are not rigid timeframes. The ASA emphasized that our formulas and recommendations are intended to provide a framework, not dictate rigid time limits. Every patient is unique, and anesthesia care must be tailored accordingly.
**WTN:** What role did the ASA play in convincing Anthem to reverse its decision?
**Dr. Morewood:** We engaged directly with Anthem executives, attempting to educate them on the nuances of anesthesia billing and the potential harm their policy could cause. We explained how using a single billing code for a wide range of procedures does not accurately reflect the time required for anesthesia.
We highlighted the lack of evidence suggesting overbilling for anesthesia services and expressed serious concerns about the policy’s focus on cost reduction over patient care.
**WTN:** This reversal is seen as a victory for patient care and medical professionals. What message do you think this sends to other insurance companies considering similar cost-cutting measures?
**Dr. Morewood:** It sends a clear message: evidence-based decision-making is crucial in healthcare. Cost containment is crucial, but it shouldn’t come at the expense of patient safety and quality care. Open dialog and collaboration between insurers and medical professionals are essential for achieving a sustainable and equitable healthcare system.
**WTN:** Dr. Morewood, thank you for your insights on this important issue.
**Dr. Morewood:** it was my pleasure.
**Note:** This interview transcript has been edited for clarity and brevity.
