Missouri proposal could block health insurers from limiting anesthesia coverage

JEFFERSON CITY — Missouri health insurance providers would be prohibited from limiting coverage of anesthesia under legislation introduced in the Missouri House.

Rep. David Tyson Smith, D-Columbia, said he is sponsoring the proposal in response to a policy change floated by Anthem Blue Cross Blue Shield and then dropped amid backlash from customers, lawmakers and trade groups.

“I know they backtracked after a lot of outrage from the public. But I thought maybe it’s best to hold their feet to the fire and keep them accountable,” Smith said. “They are making billions of dollars. They are making it difficult for people to get treatment for coverage they are paying for.”

The legislation says insurers “shall not deny coverage for anesthesia services, or impose any cap on the reimbursement amount for anesthesia services, on the basis that the duration of a procedure for which anesthesia services are performed exceeds a particular time limit.”

The insurer, which provides health coverage to an estimated 2.1 million Missourians, announced in November it would no longer pay for anesthesia care if a surgery goes beyond a specific time limit. The policy was set to go into effect in Missouri Feb. 1.

The now-scrapped billing scheme would not have applied to patients under the age of 22 or maternity-related care, according to Anthem.

The company said it would drop the plan citing “widespread misinformation” about how the change would work.

In a statement, Anthem said Smith’s legislation would not have had any effect on the initial proposal because “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 company said.

The pullback came amid intense scrutiny of the health insurance industry after the execution-style killing of the CEO of UnitedHealthcare on the streets of New York City in early December.

Police said the words “delay,” “deny” and “depose” were scrawled on the ammunition investigators found at the scene of Brian Thompson’s death, echoing a phrase commonly used to describe insurer tactics to avoid paying claims.

The suspect, Luigi Mangione, 26, has pleaded not guilty to state charges in the case.

Smith said his legislation aims to address some of those concerns.

“Health insurance companies have grown so large and powerful. Everyone knows they are constantly denying claims that really shouldn’t be denied,” Smith said. “I think this is just the start for maybe future legislation making sure they are responsive to the needs of the people of Missouri.”

In addition to Smith’s concerns, House Speaker Jon Patterson, a Lee’s Summit physician, also intervened in the dustup, calling Anthem in an attempt to gain clarity into the policy.

He told the Post-Dispatch he believed placing artificial time limits on medical procedures could be harmful to patients.

The insurance giant’s initial decision also drew scorn from the American Society of Anesthesiologists, which called the policy a “cynical money grab.”

The Missouri Society of Anesthesiologists also strongly opposed the change, saying it posed a significant threat to the safety of Missouri patients and undermined the critical role anesthesiologists play in surgical care.

The legislation is House Bill 932.

Amid backlash, insurer shelves plan to limit anesthesia coverage in Missouri

The new billing scheme does not apply to pregnant women or patients under 22.

Anthem cancels controversial anesthesia policy after widespread outrage

Anthem Blue Cross Blue Shield is canceling a proposed policy change on anesthesia coverage after extensive backlash.

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