Anthem Insurance's decision to limit anesthesia coverage based on time has sparked sharp criticism from medical professionals. The new policy, set to take effect on February 1, 2025, has drawn backlash for its potential implications on patient care.
Anthem announced the change in a November statement:
“We will utilize the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied.”
The American Society of Anesthesiologists (ASA) has strongly opposed the policy and is calling for its reversal. In their response, the ASA expressed deep concern over the impact this change could have on patient safety and care quality:
“We question how Anthem could propose paying for only a portion of the anesthesia service needed by their customers. The policy does not contemplate that an anesthesia code may apply to vastly different surgical procedures with corresponding wide variations in surgical times. It also betrays a diminished dedication to patient agency and safety on the part of Anthem.
If a surgery lasts longer than the standards accepted by Anthem, the insurer absolves itself of responsibility to pay for the anesthesia needed for the remainder of the procedure. The policy also fails to account for individual patient needs or complications that may arise during surgery, which are traditionally reflected in time-based payment structures under longstanding regulations. This proposal highlights a troubling disconnect between Anthem, its patients, and their needs.”
Exemptions from the policy will apply to patients under the age of 22 and those receiving maternity-related care. However, the ASA has urged concerned individuals to contact their state insurance commissioners or legislators to address the issue.
According to the ASA, this policy will initially affect Anthem Blue Cross Blue Shield plans in Connecticut, New York, and Missouri.
