A major insurer recently reversed course on its plan to outright deny claims for anesthesia services. According to recent policy announcements, Anthem Blue Cross Blue Shield had determined it would no longer pay for anesthesia services provided beyond arbitrarily set time limits. Patients in Connecticut, New York, and Missouri would have had claims denied if the submitted bills exceeded pre-determined times set for anesthesia care. Among the many questions this engenders, one is, who gets to decide how long a surgery needs to be? Should it be the profit-driven insurer, or the clinician providing safe care to their patient?
Anesthesia service is carefully tailored for each patient, considering such factors as patient history, type of procedure, and patient’s health at the time of the procedure. Unexpected findings are common, including complications. For instance, I talk to patients every week who have had surgeries that, in many cases, went longer than originally planned. This delay is often due to findings that cannot be discovered until the surgeon is actually looking inside the patient.”
Anthem, which reported a 24% increase in its net income and profit margin to $2.3B in 2024, claims it introduced this new policy to “safeguard against overbilling”. In its statement withdrawing the policy, Anthem also asserts that “widespread misinformation” about the policy led to confusion, and that it was meant to ‘clarify the appropriateness of anesthesia’ in line with clinical guidelines.
Though Anthem has withdrawn the policy, insurers will likely continue to try limiting clinical decision-making through reimbursement schemes that, in turn, keep money in their pockets.
The policy would further create an externalized cost, which is ultimately borne by the provider and/or the patient. As a result, the provider must spend more time, effort, and resources on an appeal to justify their billing. If the appeal is denied, the patient, consequently, remains responsible for the bill. That may lead the provider to send the patient’s bill to collections. Or the patient’s best-case scenario is for the provider to waive the bill, which means the provider remains uncompensated for their work.
Imagine, now, a world where external pressures force anesthesiologists to hurry their processes unsafely in order to ensure they receive compensation for their work. It’s not hard to see that then the burden will shift to liability insurers who are paying out claims for negligence. Anthem’s policy to decide how long surgeries must be may save them some money in the short run, but will cost significant harm to providers, patients, and other carriers.
