Anthem Blue Cross Blue Shield on Thursday reversed its decision to put a time limit on anesthesia coverage.
In an emailed statement to The Epoch Times, an Anthem spokesperson said that because of “significant widespread information,” the health insurer company chose to step back from its decision.
“As a result, we have decided to not proceed with this policy change,” the spokesperson said. “To be clear, 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.”
In a now-retracted Dec. 1 statement, Anthem said it wouldn’t cover anesthesia service beyond a set time limit based on a “Physician Work Time” metric written by the Centers for Medicare and Medicaid Services (CMS).
The time limit would have affected plans in Connecticut, New York, and Missouri, with company plans in other states expected to follow suit.
“Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount,” Anthem said.
After Anthem first announced the policy change, the American Society for Anesthesiologists (ASA) issued a statement in November saying imposing a time limit on coverage would compromise anesthesiologists’ ability to provide needed care to patients with more difficult conditions.
“With this new policy, Anthem will arbitrarily pre-determine 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 will deny payment for the anesthesiologist’s care,” the ASA stated.
“With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises.”
The policy decision was previously criticized by politicians such as Sen. Chris Murphy (D-Conn.) and New York Gov. Kathy Hochul
“Saddling patients with thousands of dollars in surprise additional medical debt,” Murphy wrote on X. “And for what? Just to boost corporate profits?”
Anthem responded to the criticism in an updated statement on its website on Thursday, stating its communication about the policy “was not clear” and that “medically necessary anesthesia would have been paid under the update.”
“In circumstances when anesthesia providers went outside of well-established clinical guidelines they would have been able to submit medical documentation to support accurate payment,” Anthem said.
The Associated Press and Jack Phillips contributed to this report.
