Anthem Blue Cross Blue Shield said Thursday that the health insurance provider is reversing a policy that was set to go into effect in February that would have limited anesthesia coverage during surgeries and other procedures, a change that had prompted an outcry from some physicians and lawmakers.
The policy, which would have covered Anthem’s plans in Connecticut, New York and Missouri, was disclosed in recent weeks, with the company’s New York unit posting a notice on Dec. 1. The policy would have excluded people under 22 years old and maternity care.
According to the original policy statement, Anthem had said it would pay only for anesthesia treatments for the length of time that a procedure or surgery is estimated to require based on the Centers for Medicare and Medicaid Service’s physician work time values. The insurer noted that claims for anesthesia “above the established number of minutes will be denied.”
In an email to CBS News on Thursday, Anthem said it was backing away from the policy, and added there had been “widespread misinformation about an update to our anesthesia policy.”
“As a result, we have decided to not proceed with this policy change,” an Anthem spokesperson wrote in an email. “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 proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
Before the announcement of Anthem’s reversal, the plan had drawn criticism from medical professionals as well as Connecticut Senator Chris Murphy, a Democrat, who wrote on social media on Wednesday that the plan is “appalling.”
“Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits?” Murphy wrote. “Reverse this decision immediately.”
Connecticut Comptroller Sean Scanlon told the Hartford Courant Thursday that the policy would not take place in his state after negotiating with the insurer.
“After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I’m pleased to share this policy will no longer be going into effect here in Connecticut,” Scanlon told the newspaper.
“Appalling behavior by commercial health insurers”
In a statement last month, the American Society of Anesthesiologists also called on Anthem to reverse the policy.
“With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure,” the group said. “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.”
The insurer’s new policy could result in denials of coverage to patients who might need more anesthesia because their surgery is difficult or unusual, or if a complication occurs, the group added.
“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said Donald E. Arnold, an anesthesiologist and president of the American Society of Anesthesiologists. “This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need.”
