Anthem Blue Cross Says It Will Put Time Limits on Anesthesia Coverage, Alarming Officials

The office building of health insurer Anthem is seen in Los Angeles, Calif., on Febr. 5, 2015. Gus Ruelas/Reuters

Anthem Blue Cross, one of the largest health insurance providers in the United States, said that in several states starting early next year it will not always fully cover anesthesia.

In a statement posted on its website Dec. 1, Anthem confirmed that it will not cover the full length of anesthesia during surgery if it goes beyond a specific time limit.

“We will use the [Centers for Medicaid Services] Physician Work Time values to target the number of minutes reported for anesthesia services,” the statement said. “Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount.”

The update, according to Anthem, “will not change industry standard coding requirements or the ASA anesthesia formula,” referring to an acronym for the American Society of Anesthesiologists.

Exceptions will be made for individuals aged 22 and younger as well as for maternity-related care such as pregnancies and child deliveries, according to the Dec. 1 statement. The change will impact all others receiving Anthem Blue Cross coverage in New York, Connecticut, and Missouri, according to the ASA.

While the policy change was first announced last month, it drew outrage this week on social media, including from government officials. It’s scheduled to go into effect starting Feb. 1, 2025.

“This is appalling,” Sen. Chris Murphy (D-Conn.), who represents one of the states that would be impacted by the change, wrote on social media Tuesday. “Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits? Reverse this decision immediately.”

New York Gov. Kathy Hochul called the move “outrageous” in a post on X, adding that she will “make sure New Yorkers are protected.”

On Thursday, Rep. Ro Khanna (D-Calif.) described the decision as “appalling,” adding that the “current system is broken” before promoting a “Medicare for All” policy for health care coverage.

In mid-November, the ASA issued a statement that was critical of Anthem’s announcement, describing the decision as a unilateral and “unprecedented move” before calling on Anthem to “reverse this proposal immediately.”

“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” Donald E. Arnold, an ASA official, said in a statement, saying that it will break trust between the company and policyholders.

He added, “It’s 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.”

In response to some of the criticism, Anthem issued a new statement this week saying that the company is trying “to make health care simpler and more affordable,” describing the change as a coding issue.

“One of the ways to achieve that goal is to help ensure that claims are accurately coded, and providers are reimbursed appropriately for the services they provide to members,“ the company added. ” Improper coding drives healthcare costs higher than they otherwise would be.”

Anthem did not immediately respond to a Thursday request for comment from The Epoch Times.