Anthem BCBS backs down on plan to limit anesthesia coverage

Anthem Blue Cross Blue Shield is backing down from a plan that would have set limits on the amount of time it would pay for anesthesia in certain surgeries.

In November, Anthem had told health care providers that its plans in Connecticut, New York and Missouri would no longer pay for anesthesia care if the surgery or procedure were to go beyond a specified time limit, regardless of how long the surgical procedure took. The change was to take effect Feb. 1, 2025. At the time of its announcement, Anthem said the change is part of an effort to make health care more affordable by reducing overbilling for anesthesia.

Exceptions were to be made for surgeries on patients under the age of 22 and for anesthesia administered in maternity-related care.

After an association of medical professionals went public with their concerns about the plan, a spokesperson for Elevance Health, Anthem's parent company, told InsuranceNewsNet the insurer has "decided to not proceed with this policy change."

"There has been significant widespread misinformation about an update to our anesthesia policy," said Janey Kiryluik, staff vice president, corporate communications, with Elevance Health.

"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."

The American Society of Anesthesiologists, which represents 59,000 members, had called on Anthem to reverse this policy, calling it “another example of insurers putting profits over patients.”

In a news release, the ASA said 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 afterward. With this new policy, Anthem would have pre-determined the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submitted a bill where the actual time of care was longer than Anthem's limit, Anthem would then have denied payment for the anesthesiologist’s care, according to the ASA. “With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises,” the association had said.

ASA had urged people concerned about Anthem’s proposal to contact their state insurance commissioner or state legislator.

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Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].