Anthem Blue Cross Blue Shield has rolled back a policy change that would have capped payments for anesthesia services and denied claims if procedures exceeded a specific time limit. The move comes after widespread criticism from anesthesiologists, legislators, and the public.
The proposed policy was set to be tested before being implemented nationwide but sparked controversy due to its potential impact on patient care. Anesthesiologists argued that the change in reimbursement would have overturned a standard formula used since the 1990s, which takes into account variable lengths of time for procedures.
Dr. Don Arnold, president of the American Society of Anesthesiologists, described the policy as “unprecedented” and warned that it could compromise patient care. Gov. Kathy Hochul of New York expressed her opposition to the policy on social media, stating that she would ensure New Yorkers’ protection.
Anthem’s parent company, Elevance Health, attributed the reversal to incorrect communication with providers about the policy change. The company clarified that it will continue to pay for medically necessary anesthesia services and has adjusted its policy to require documentation for certain charges.
The policy change was initially intended to apply to commercially insured patients starting in February 2025, but the new guidance states that claims submitted with reported times exceeding established limits would be denied. However, this rule does not apply to maternity care or pediatric patients under 21 years old.
Source: https://www.nytimes.com/2024/12/05/health/blue-cross-blue-shield-anesthesia-anthem.html