Anthem Blue Cross Blue Shield Reverses Anesthesia Coverage Limit Policy
Indianapolis, Friday, 6 December 2024.
Anthem Blue Cross Blue Shield reversed its plan to impose time limits on anesthesia coverage due to backlash from medical professionals and the public, ensuring patient safety remains prioritized.
Policy Reversal Details
Anthem Blue Cross Blue Shield (Anthem BCBS) announced on December 5, 2024, that it would not proceed with its controversial plan to limit anesthesia coverage during medical procedures [1][2]. The policy, which was originally set to take effect in February 2025, would have affected patients in multiple states including New York, Connecticut, and Missouri [3][4]. The insurance giant cited ‘significant widespread misinformation’ about the policy update as the reason for its reversal [1][5].
Scope and Impact
The proposed policy would have used Centers for Medicare and Medicaid Services (CMS) physician work time values to determine coverage limits for anesthesia services [1]. The plan included exemptions for maternity-related care and patients under 22 years of age [3][5]. Medical professionals, particularly anesthesiologists, strongly opposed the policy, arguing that surgery durations are unpredictable and vary based on patient conditions [3]. Dr. Kenneth Stone emphasized that while a gallbladder removal might take 45 minutes in a healthy patient, it could require two to three hours for older or sicker patients [3].
State-Level Intervention
Several state officials played crucial roles in opposing the policy. Connecticut Comptroller Sean Scanlon confirmed the policy’s reversal after direct intervention [2][3]. New York Governor Kathy Hochul also successfully pushed for the policy’s cancellation, describing it as ‘misguided’ [1][4]. Connecticut Attorney General William Tong praised the reversal, pointing out the impracticality of the policy, stating, ‘What did Anthem expect doctors to do? Wake patients up in the middle of surgery?’ [3].
Professional Response and Future Implications
The American Society of Anesthesiologists (ASA) had strongly opposed the policy, characterizing it as an unprecedented move that ignored the ‘nuanced, unpredictable human element’ of surgery [1]. Dr. Jonathan Gal, economics committee chair of the ASA, described the proposed policy as a ‘money grab’ [1]. The reversal represents a significant victory for medical professionals and patient advocacy groups, reinforcing the importance of maintaining flexible, patient-centered healthcare policies [4][5].