Topline
Health insurer Anthem Blue Cross Blue Shield says it is no longer planning a policy change that would place time limits on coverage for anesthesia services in Connecticut, New York and Missouri—a reversal after the move drew widespread outrage this week.
The company told Forbes there had been “significant widespread misinformation” about the policy and … [+] as a result they are not proceeding with the change.
Key Facts
Anthem Blue Cross Blue Shield announced in November it would begin changing how it processes anesthesia claims in the three states on Feb. 1, 2025, by limiting the amount of time it covers anesthesia for surgeries and procedures in which it’s needed.
The announcements for the three states said the company would begin denying “claims submitted with reported time above the established number of minutes” initially targeted for anesthesia services—though the policy would not apply for people under 22 or maternity-related care.
The policy change drew quick backlash from the American Society of Anesthesiologists, which published a press release on Nov. 14 saying Anthem “will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes.”
The change drew more criticism Thursday as a greater spotlight was placed on health insurance companies following the killing of Brian Thompson, UnitedHealthcare’s CEO, with at least one lawmaker weighing in and calling the change “appalling,” and a number of doctors criticizing the move to CNN.
Janey Kiryluik, staff vice president of corporate communications at Anthem’s corporate parent Elevance Health, told Forbes Thursday the company will “not proceed with this policy change” after there was “significant widespread misinformation” around the update, and when asked which states it will not take effect in she said the decision “applies across the board.”
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Contra
“To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” Kiryluik told Forbes in a statement. “The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
Chief Critic
“The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of Anthem,” the American Society of Anesthesiologists said in a statement after the policy was reversed. “ASA welcomes Anthem’s decision but notes that Anthem’s recent policy proposal reflects a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms.”
Surprising Fact
Elected officials in Connecticut and New York both said they stepped in Thursday to intervene with Anthem’s new plan before the company announced the reversal. New York Gov. Kathy Hochul said on X, formerly known as Twitter, the change was “outrageous” and she would “make sure New Yorkers are protected.” Connecticut’s comptroller Sean Scanlon said his office had already reached out to Anthem and the policy would “no longer be going into effect here in Connecticut.” Scanlon shared that update hours before Anthem announced the reversal.
Tangent
Thompson’s death brought more attention to the health insurance industry as his killing roused conversations online of healthcare in America. Thompson, who was the chief executive of UnitedHealthcare—the health insurance division of the $550 billion UnitedHealth Group—was fatally shot by an unknown gunman on Wednesday while on his way to UnitedHealth Group’s investor meeting in New York City. Police had not named a suspect or motive as of Thursday evening and were still hunting for the suspect, but the New York City police commissioner called the shooting “a brazen targeted attack.” Multiple outlets reported Thursday that bullet casings from the scene had on them the words “deny,” “defend” and “depose”—which are alleged tactics insurance companies are accused of using to avoid paying claims. The words echo a common phrase used by critics of the health insurance industry: “delay, deny, defend.”
Further Reading
CNNDoctors are raising alarm about insurance company’s plan to put time limit on coverage for anesthesia during surgery | CNNWashington PostAnthem Blue Cross Blue Shield reverses plan to limit anesthesia coverageForbesUnitedHealthcare CEO Fatally Shot In NYC: Police Still Searching For Gunman (Updates)By Lindsey Choo
