Anthem Blue Cross Blue Shield reverses decision to cap anesthesia coverage after a set time limit

ROCHESTER, N.Y. (WROC/AP) — One of the country's largest health insurers reversed a change in policy Thursday after widespread outcry, saying it would not tie payments in some states to the length of time a patient went under anesthesia.

Anthem Blue Cross Blue Shield said in a statement that its decision to backpedal resulted from "significant widespread misinformation" about the policy.

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

Anthem Blue Cross Blue Shield would have used "physician work time values," which is published by the Centers for Medicare and Medicaid Services, as the metric for anesthesia limits; maternity patients and patients under the age of 22 were exempt. But Dr. Jonathan Gal, economics committee chair of the American Society for Anesthesiologists, said it's unclear how CMS derives those values.

The cutoff would have applied to patients in New York State, Missouri and Connecticut.

People across the country registered their concerns and complaints on social media, and encouraged people in affected states to call their legislators. Some people noted that the policy could prevent patients from getting overcharged.

Gal said the policy change would have been unprecedented, ignored the "nuanced, unpredictable human element" of surgery and was a clear "money grab."

Officials with BCBS previously announced the cutoff would begin with claims processed on or after Feb. 1, 2025. BCBS said at that time that it would "utilize the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied."

There were some exemptions, including patients under the age of 22 and patients in need of maternity-related care.

Prior to Anthem's announcement of the reversal, Connecticut Comptroller Sean Scanlan posted on X (formerly Twitter) that the company was backing down in that state. "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."

Meanwhile, New York Governor Kathy Hochul previously wrote via X, "Outrageous. I'm going to make sure New Yorkers are protected."

The American Society of Anesthesiologists (ASA) blasted the move in a November news release discussing Anthem's plans.

"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 group said, in part.

In a statement shared by the ASA, Dr. Donald E. Arnold called the move "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," Arnold added.

Nexstar's WROC reached out to Anthem BCBS for comment but had not received a response by the time of publication.