Anthem backs down from decision to cap anesthesia coverage in CT, official says

Anthem Blue Cross Blue Shield is backing off a decision that could have led to the health insurer not paying for the full duration of anesthesia if a surgery in Connecticut goes longer than a predetermined time limit, according to the state comptroller. The decision to back down followed blowback from state leaders and a national association, although the company said there was "widespread misinformation" about the possible change.

Beginning in February, Anthem Blue Cross Blue Shield in Connecticut, New York and Missouri would have only paid for anesthesia within a time limit set previously by the insurer, according to the American Society of Anesthesiologists. It was unclear why only those three states would have been affected, but another notice indicated Colorado could follow those states in March.

The company said in a statement that because of the "significant widespread misinformation" the company would not go forward with any policy change.

"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 wrote. "The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

American Society of Anesthesiologists President Donald E. Arnold called the proposal "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."

"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," Arnold said in a statement. "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."

State Sen. Saud Anwar, D-South Windsor, Senate Chair of the Public Health Committee, said he was "outraged" over the policy and vowed to look for ways to change state law if the policy went forward.

"A policy like this is directly dangerous to patients' well-being, regarding the quality of the procedures they receive and the financial strain they could face after the fact," Anwar said in a statement.

State Sen. Jeff Gordon, R-Woodstock, who is also a practicing physician, said in a November letter to Anthem that there are many real-world scenarios in which that policy will result in possibly terrible outcomes.

If, for example, "a woman is undergoing a hysterectomy for fibroid bleeding, and her surgeon makes a medical decision within accepted standards of care to extend the surgery time to control bleeding in the surgical field," Gordon said there will be only two possible options.

The surgeon and anesthesiologist could, Gordon wrote, continue the surgery perhaps beyond the patient's ability to pay, "possibly leading to crippling medical debt," or stop the surgery.

"As you know, there are many clinical reasons why a surgery or procedure could run longer than its scheduled time," Gordon wrote.