Anthem Blue Cross Blue Shield, one of the nation’s largest health insurers, has reversed its decision to cap reimbursement for anesthesia care based on surgery time limits. The policy, slated to take effect in February, faced strong opposition from healthcare providers, policymakers, and patient advocates. Anthem announced Thursday it will not proceed with the policy, citing “widespread misinformation” and concerns raised about the update.
The initial policy aimed to use CMS metrics to determine allowable anesthesia time for reimbursement. Claims exceeding these time limits would have been reimbursed only up to CMS standards. Anthem stated the goal was to prevent overbilling and align with clinical guidelines. Exceptions were planned for maternity care and patients under 22, and providers could challenge reimbursement decisions.
The policy drew immediate criticism, especially from the American Society of Anesthesiologists (ASA), which labeled it a “cynical money grab.” The ASA warned that the policy could force patients to cover additional costs for essential care, potentially amounting to thousands of dollars. ASA President Dr. Donald Arnold said it undermined trust between insurers and patients, adding that determining anesthesia time arbitrarily risks patient safety during complex procedures.
Connecticut, New York, Missouri, and Colorado were expected to be the first states impacted. Connecticut officials, including State Comptroller Sean Scanlon and Senator Chris Murphy, intervened, urging Anthem to reverse course. Anthem confirmed Wednesday that the policy would not be implemented in Connecticut, and by Thursday, the insurer had scrapped the proposal nationwide.
Anthem’s statement emphasized its commitment to reimbursing medically necessary anesthesia services and ensuring accurate claims processing. The insurer framed the policy as part of efforts to control healthcare costs, citing the impact of improper coding. Critics, however, pointed to Anthem’s significant profit growth, with net income rising 24.12% to $2.3 billion in June, as evidence of prioritizing profits over patient care.
