Anthem Blue Cross and Blue Shield Reverses Policy Change on Anesthesia Coverage
Background
Anthem Blue Cross and Blue Shield had proposed a policy change that could have put time limits on coverage of anesthesia for some extended surgical or other procedures. The policy would have taken effect on February 1 and impacted plans in New York, Connecticut, and Missouri.
Proposed Policy Change
The proposed policy change would have limited payment for anesthesia care of surgeries or procedures that were extended beyond a designated time limit. Anthem would have used CMS Physician Work Time to "target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied."
Reaction from American Society of Anesthesiologists
The American Society of Anesthesiologists (ASA) called the move "unprecedented." ASA stated that the policy would have arbitrarily pre-determined the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem’s limit, Anthem would have denied payment for the anesthesiologist’s care.
State Intervention
On Thursday, Connecticut State Comptroller Sean Scanlon announced that the policy would not go into effect in Connecticut. Anthem also confirmed that the policy would not go into effect, stating that there had been significant widespread misinformation about the update to their anesthesia policy.
New York Governor’s Response
New York Governor Kathy Hochul shared her concerns with Anthem on Wednesday night and expressed her outrage at the plan to strip away coverage from New Yorkers who had to go under anesthesia for surgery. She praised Anthem’s decision to reverse course, stating that "don’t mess with the health and well-being of New Yorkers – not on my watch."
Exclusions
Patients under the age of 22 years old or in maternity care would have been excluded from the policy.
Conclusion
Anthem Blue Cross and Blue Shield’s decision to reverse its policy change on anesthesia coverage is a welcome relief for patients and healthcare providers. The proposed policy change would have had significant implications for patients undergoing extended surgical or other procedures, and its reversal ensures that patients will continue to receive necessary anesthesia care.
FAQs
Q: What was the proposed policy change by Anthem Blue Cross and Blue Shield?
A: The proposed policy change would have limited payment for anesthesia care of surgeries or procedures that were extended beyond a designated time limit.
Q: Which states were impacted by the proposed policy change?
A: The proposed policy change would have impacted plans in New York, Connecticut, and Missouri.
Q: What was the reaction from the American Society of Anesthesiologists?
A: The American Society of Anesthesiologists (ASA) called the move "unprecedented" and stated that the policy would have arbitrarily pre-determined the time allowed for anesthesia care during a surgery or procedure.
Q: Did the policy change go into effect?
A: No, the policy change did not go into effect. Connecticut State Comptroller Sean Scanlon announced that the policy would not go into effect in Connecticut, and Anthem confirmed that the policy would not go into effect.
Q: What was the response from New York Governor Kathy Hochul?
A: New York Governor Kathy Hochul shared her concerns with Anthem on Wednesday night and expressed her outrage at the plan to strip away coverage from New Yorkers who had to go under anesthesia for surgery. She praised Anthem’s decision to reverse course.
