Anthem Blue Cross Blue Shield Anesthesia Coverage: Policy Change Explained
The health insurance provider’s new policy regarding anesthesia care for surgical procedures has sparked outrage, leading them to reverse the decision. Find more updates here.
Doctors, patients, and even politicians strongly reacted to the news that major health insurance provider Anthem Blue Cross Blue Shield was changing one of its coverage policies. According to multiple outlets, the company announced a shift in coverage that would no longer pay for anesthesia care if an operation exceeds a specific time limit. The policy change was set to affect patients in Connecticut, New York, and Missouri. However, following the widespread outrage, the decision has been quickly reversed.
Find out more about why this change was reversed and what it means for patients below.
What Is Anthem Blue Cross Blue Shield’s New Policy?
Blue Cross Blue Shield will no longer cover anesthesia for the full length of certain surgeries in Connecticut, New York, and Missouri.
If a surgery exceeds a specific duration, anesthesia costs for the additional time will not be covered. pic.twitter.com/Sniwxze8XV
— Pop Crave (@PopCrave) December 4, 2024
The policy would no longer reimburse anesthesia services for the complete duration of certain surgical procedures, opting instead for a partial coverage model.
Anthem Blue Cross Blue Shield announced the policy change on November 1, 2024. At the time, the company indicated that this insurance update would begin in 2025.
“Beginning with claims processed on or after February 1, 2025, Anthem will change how it evaluates billed time on professional claims for anesthesia services,” Anthem announced in a 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 company also noted that its policy update “will account for anesthesia work time included in the pre-service evaluations, intra-service period, and post-service period.”
“The appropriateness of billing for pre- and post-operation time must be documented and follow the guidelines established by the ASA as to the appropriate time that should be counted and documented,” Anthem announced.
The policy would not affect patients under the age of 22 or those in maternity care.
Will Blue Cross Patients Pay Out of Pocket?
The American Society of Anesthesiologists indicated that, under this new policy, patients would have to pay out of pocket for anesthesia-related care if a procedure exceeds a time limit.
However, the policy may not affect Connecticut residents. State Comptroller Sean Scanlon acted promptly and reached out to Anthem.
“After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I’m pleased to share this policy will no longer be going into effect here in Connecticut,” Scanlon said, according to NBC Connecticut.
What Has Been the Reaction to the New Policy?
This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt.
And for what? Just to boost corporate profits?
Reverse this decision immediately. https://t.co/0x4jBVqyKi
— Chris Murphy 🟧 (@ChrisMurphyCT) December 4, 2024
Senator Chris Murphy was one of the many who voiced his opposition to the proposal, calling it “appalling” on X (formerly known as Twitter).
“This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt,” Murphy tweeted, adding, “And for what? Just to boost corporate profits? Reverse this decision immediately.”
The American Society of Anesthesiologists also reacted to Anthem’s policy change. In a statement, the ASA noted, “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.”
How Much Does Anesthesia Care Cost in America?
It depends where a patient undergoes an operation, but anesthesia care can cost anywhere between $200 to more than $1,000, according to multiple outlets. My Sleep Guardian reports that the cost of anesthesia is typically $400 for the first 30 minutes of care and $150 every additional 15 minutes.