Anthem BCBS to cap anesthesia coverage after time limits : NPR

Doctors and policymakers are sounding the alarm after the nation’s largest health insurance company announced that starting next year it will stop paying for anesthesia treatments in some states if the surgery or procedure exceeds a certain deadline. It’s ringing.

Starting in February, Anthem Blue Cross Blue Shield will use a metric known as the Centers for Medicare and Medicaid Services (CMS) Physician Time Value to “target the number of minutes reported for anesthesia services.” states.

“Claims submitted with time reported in excess of the set number of minutes will only be paid up to the amount set by CMS.” I said it in a note to a New York provider earlier this week.

It’s unclear which states will roll out the policy first. of American Association of Anesthesiologists (ASA) announced that the measure will go into effect in Connecticut, New York, and Missouri. And that is similar notice It was also issued to providers in Colorado, with a start date in March.

NPR has contacted Anthem for more information.

Anthem exempts obstetric-related care and patients under 22 years of age, and says providers can take steps to contest claims if they disagree with reimbursement decisions.

Still, the backlash against the announcement was swift, especially after the fatal shooting of another health insurance company’s CEO captivated social media and drew even more attention to the industry.

The announcement left a trail of anger and fear across social media, with users making jokes. I woke up in the middle of the surgery. And I’m worried that the doctor will have to rush the procedure. However, some say it is difficult to standardize anesthesiologists’ salaries at a fixed rate. actually beneficial For patients who might otherwise be overcharged – this is what Anthem also claims.

Anesthesiologists accuse Anthem of putting profits before patients

Mid-November, ASA issued a statement He called the policy a “cynical money grab” and urged Anthem to immediately reverse the policy.

“This egregious policy undermines the trust between Anthem and its policyholders, who expect their health insurance companies to pay their doctors the full cost of necessary treatment,” said ASA President Dr. Donald Arnold. There is,” he said.

Payment for anesthesia services is determined based on multiple factors, including the exact amount of time an anesthesiologist needs to provide care before, during, and immediately after surgery, the society explained.

The ASA said that by “arbitrarily” determining the time allotted for anesthesia care during surgery, Anthem “does not require special consideration because the surgery is difficult, unusual, or presents complications.” “It would not pay anesthetists who provide safe and effective care to patients who need it.” . ”

In this case, the patient will be burdened with the burden. Out-of-pocket costswhich can range from a few hundred dollars to a few thousand dollars.

“This is just the latest in a series of horrific actions by private health insurance companies seeking to increase profits at the expense of patients and doctors providing essential care,” Arnold said.

ASA noted that Anthem, which recently rebranded to Elevance Health, reported a 24.12% year-on-year increase in net profit to $2.3 billion in June.

Anthem has not responded to NPR’s request for comment. However, in the statement provided, FOX61 in Connecticutcharacterized the decision as a way to “prevent overcharging potential anesthesia providers.”

“Anthem is committed to making healthcare simpler and more affordable,” the company said. “One way to achieve that goal is to ensure that claims are accurately coded so that providers are properly reimbursed for the services they provide to members. It makes costs higher than they would otherwise be.”

Elected officials are involved

The ASA encourages people concerned about changes to their insurance policies to contact their state insurance commissioner or legislator.

And as news of Anthem’s announcement spread across social media this week, elected officials in some affected states issued their own calls to action.

New York Governor Cathy Hochul called the decision “outrageous.” she said she would “We will make sure New Yorkers are protected,” he said, but did not say how he would do that.

“Does Anthem expect patients to get up and walk away mid-surgery?” New York State Senator Mike Gianaris tweeted on Wednesday. “I plan to introduce legislation to ban this practice and protect patients who need our care.”

Sen. Chris Murphy, R-Connecticut, publicly called on Anthem to change course immediately.

“This is horrible, leaving patients with staggering thousands of dollars in additional medical debt.” Murphy tweeted. “For what? Just to increase corporate profits?”

Jeff Gordon, a Republican state senator from Connecticut, works as an oncologist and hematologist. sent a letter Last month, Connecticut National Anthem Blue Cross and Blue Shield called for the decision to be reversed, saying “people’s health care and lives are at stake.”

In his letter, Gordon asked for more information about why the company set the deadline, including whether it is supported by any research or data.

“This policy is antithetical to providing quality, safe health care to the people of Connecticut and other states,” he wrote. “It can lead to avoidable adverse events and unnecessary bad outcomes. Why would Anthem BCBS pursue such a policy?”

Gordon reiterated that there are many reasons why a surgery or procedure may take longer than expected, including unforeseen issues.

For example, if a woman has a hysterectomy due to fibroid hemorrhage and the surgeon decides to extend the operation time to control the bleeding, do the surgeon and anesthesiologist follow Anthem’s policy and stop the surgery? , he said, will need to decide whether to continue seeing patients. They will have to incur additional costs, which “could lead to catastrophic medical debt.”

Anthem’s anesthesia coverage restrictions “ignore these real-world medical circumstances,” he added, calling on the company to “do the right thing.”