Anthem Blue Cross Blue Shield has abandoned a plan to cap payouts on anesthesia claims in certain states.
Critics including lawmakers and physicians had accused the company, one of the nation’s largest insurers, of potentially degrading care and saddling customers with thousands of dollars in unexpected bills.
“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change,” the company told The Independent in a statement. “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.”
Under the policy at issue, Anthem was set to use estimates for the length of procedures established by the government Centers for Medicare & Medicaid Services (CMS) to evaluate anesthesia claims. In a note to providers about the now-abandoned plan, the company said it would only “pay up to the CMS established amount” for anesthesia services. Patients under 22 and those receiving maternity care were exempted from the policy.
State officials celebrated the reversal.
“We pushed Anthem to reverse course on their decision to strip anesthesia coverage away from New Yorkers and today they will be announcing a full reversal of this misguided policy,” New York Governor Kathy Hochul wrote on X on Thursday. “Don’t mess with the health and well-being of New Yorkers — not on my watch.”
“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,” Connecticut Comptroller Sean Scanlon wrote on X.
The policy was set to take effect Connecticut, New York, and Missouri, according to the American Society of Anesthesiologists. Notes to providers suggested the change would take effect in spring of 2025. The society accused Anthem of seeking to “unilaterally” limit coverage based on an “arbitrary time limit.”
“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,” Dr. Donald E. Arnold, president of the group, said in a November statement. “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.
Governor Hochul had criticized the Anthem policy as “outrageous,” while Senator Chris Murphy of Connecticut branded it “appalling” in a post on X and warned it would result in “saddling patients with thousands of dollars in surprise additional medical debt.”
“And for what? Just to boost corporate profits?” he continued. “Reverse this decision immediately.”
Doctors, meanwhile, warned that the policy could impact care and doesn’t account for the many reasons a surgery or procedure might take longer than a general pre-set formula.
“There are many real-world examples that I can provide as a medical doctor that illustrate how a predetermined time limit for anesthesiology coverage is not reasonable because there are many other medical factors at play,” Jeff Gordon, a Republican state senator and physician for Connecticut, wrote in a statement last month. “Each patient is different. Each surgery is different.”
The average price of anesthesia in outpatient visits rose 20 percent between 2018 and 2022, to $989, according to the Health Care Cost Institute.
Anthem had previously framed the anesthesia plan as a way to actually reduce costs on patients by standardizing claims.
“We at Anthem strive to make health care simpler and more affordable,” the company told CNN. “One of the ways to achieve that goal is to help ensure that claims are accurately coded, and providers are reimbursed appropriately for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”
Eric Levitz, a correspondent at the progressive news outlet Vox, argues that there could be an upside to the policy change, noting in a post on X that “the alternative to capping pay rates to doctors who make $400,00+ a year is to have everyone pay higher premiums to support their extortionary billing.”
The heated public discussion around healthcare costs follows the Wednesday shooting of UnitedHealthcare CEO Brian Thompson outside a New York City hotel, in what police suspect was a targeted attack.
