Anthem Blue Cross Blue Shield's decision to cap anesthesia coverage based on arbitrary time limits has sparked outrage among medical professionals, who think "it's a cynical money grab" that prioritizes profits over patient safety.
In November 2024, the American Society of Anesthesiologists (ASA) sounded the alarm about Anthem's new policy which dictates that anesthesia services will only be covered up to pre-determined time limits. The complexity or duration of the surgery will not be taken into account, the ASA reported.
Anthem, citing concerns about overbilling, claims the move aligns with federal guidelines.
On the other hand, critics argue the decision is profit-driven and risks leaving patients with unexpected out-of-pocket expenses.
"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," Donald E. Arnold, M.D., FACHE, FASA, said. "It's a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care. 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."
This policy follows Anthem's reported $2.3 billion net income increase in June 2024, according to Fox 61.
Medical professionals and lawmakers are calling for immediate action to reverse the policy. Dr. Kenneth Stone, a Connecticut anesthesiologist, criticized Anthem for undermining patient care, noting that surgery durations often extend due to unforeseen complications like blood loss or complex anatomy.
Nevertheless, Anthem has defended the policy as a way to "safeguard against overbilling," offering a review process for claims exceeding the limit.
However, patients and doctors remain concerned about financial uncertainty and diminished trust in the insurer.
The policy is set to take effect in February 2025, with exemptions for maternity and pediatric cases and for Connecticut providers.
If implemented, the policy could lead to increased financial strain on patients and undermine trust in Anthem's coverage.
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