Anthem Blue Cross Blue Shield announced Thursday that it will not move forward with policy changes that would limit reimbursement for anesthesia costs for surgeries and medical procedures. The new insurance would reimburse doctors based on deadlines set by the insurance company.
Anthem BCBS, one of the largest health insurance companies in the United States, quietly announced a new reimbursement policy last month. connecticut, new york and missouri From February. This policy change sparked outrage from the public. American Association of Anesthesiologists.
Initially, this policy update went unnoticed, but it was changed on Wednesday. After UnitedHealthcare CEO Brian Thompson was shot and killed in New York City. The killing sparked a wave of online outrage about the U.S. health care system, and Anthem BCBS' decision added to the conversation.
A spokesperson for Anthem BCBS said in a statement: “Significant misinformation is being circulated regarding the update to our hospital's anesthesia policy. As a result, we have decided not to proceed with this policy change.”
The spokesperson continued, “To be clear, it has never been and will not be Anthem Blue Cross Blue Shield's policy to not pay for medically necessary anesthesia services. The proposed update is intended solely to clarify the appropriateness of anesthesia along the following lines.” It is a well-established clinical guideline. ”
Prior to the reversal, New York and Connecticut had intervened to prevent the plan from being implemented.
On Thursday, New York Gov. Cathy Hochul took credit for pushing for the reversal. Mr. Hochul expressed his anger towards X. on wednesday.
“Last night, I shared my anger at Anthem's plan to strip insurance from New Yorkers who had to undergo anesthesia for surgery,” Hochul said in a statement Thursday. “We urged Anthem to change course, and today Anthem is announcing a complete reversal of this misguided policy.”
On Thursday, Connecticut State Comptroller Sean Scanlon said: Posted in X That policy would no longer be in effect in the state.
In an interview with NBC News, Scanlon said he doesn't believe there is a direct correlation between the policy cancellation and the insurance executive's murder.
“I think these are two separate issues,” Scanlon said.
He said the reversal was a victory for the people of Connecticut.
“I was really happy to see people speaking up and I was happy to see Anthem reconsidering their decision,” he said.
The surgeon decides the timing of the surgery
There is usually no set time limit for anesthesia during a surgery or procedure. Anesthesia is administered throughout the procedure. That decision is made by the physician performing the procedure, not the anesthesiologist.
“The problem here is that the time or length of the surgery is the role of the surgeon, not the anesthesiologist. ,” said Dr. Divya Srinivasa, founder and chief surgeon of the Advanced Breast Reconstruction Institute in Los Angeles.
“In my field, I'm a breast reconstructive surgeon. How long it takes depends on the complexity,” Srinivasa said.
An Anthem BCBS spokesperson said Wednesday afternoon that as part of the company's “continuing efforts to improve affordability and access to care,” the company is working to “prevent overcharging potential anesthesia providers.” He said this decision had been taken.
A spokesperson said, referring to the Centers for Medicare and Medicaid Services, that Anthem “uses CMS physical work time values to determine the appropriate number of minutes” for procedures.
Dr. Donald Arnold, president of the American Society of Anesthesiologists, sharply questioned how Anthem determined the time limit.
“No, it’s not part of Medicare or Medicaid,” he said. “No one else has a system like this.”
The CMS Physician Hours Value is CMS website.
“Medicare has some data,” Arnold said. “We don't know what the data is for. We don't know where it comes from. We don't know how it's calculated. We don't know anything about it except that we can find and download the spreadsheet. It doesn't answer our questions to understand how it was developed.”
On Friday, a CMS spokesperson said Medicare covers anesthesia without a specific deadline and does not limit payment for anesthesia services.
“CMS pays for anesthesia services in 15-minute increments, with additional fixed payments to account for the complexity of the procedure,” the spokesperson said in a statement.
In January, Blue Cross Blue Shield of Massachusetts began restricting the use of anesthesia during colonoscopies. overturned that decision In response to backlash from doctors, American College of Gastroenterology.
