Elevance has withdrawn a controversial plan to put a time limit on the use of anesthesia for certain surgeries after public outcry and opposition from doctors' groups.
The policy change was scheduled to take effect in February for Anthem Blue Cross Blue Shield members in New York, Connecticut and Missouri. The news had been under the radar since it was announced last month, but it came back into the public eye on Wednesday after UnitedHealthcare CEO Brian Thompson was shot and killed in New York City. The executive's death sparked a wave of anti-health insurance company sentiment online.
In an email to Healthcare Dive on Thursday, an Elevance spokesperson said, “There has been significant misinformation circulating regarding updates to our hospital's anesthesia policy.” “As a result, we have decided not to proceed with this policy change.”
“It has not been, and will not be, Anthem Blue Cross Blue Shield's policy not to pay for medically necessary anesthesia services,” a spokesperson said. The proposed policy update is intended solely to clarify the appropriateness of anesthesia consistent with established clinical guidelines. ”
According to the Anthem Provider Newsletter, the insurer planned to use physician hour values set by CMS as the basis for anesthesia coverage. Any claims submitted for services that take longer than the configured minutes will be rejected. People under 22 and maternity care would have been exempted from the policy.
The American Association of Anesthesiologists strongly opposed the change, saying in a letter to Elevance CEO Gail Boudreau that tying CMS estimates of anesthesia coverage and service time is “unacceptable.” “This is not a reliable or reasonable payment method.” Elevance is the parent company of Anthem branded plans.
“CMS Physician Hours was not developed and was never intended to support reporting or payment for anesthesia services,” the ASA said in a Nov. 12 letter.
Typically, there is no set reimbursement deadline for anesthesia. Instead, pain management treatment extends as long as the doctor needs to perform surgery or other medical services. The ASA says this is important because surgery time can be extended if complications occur.
A study published last year found that doctors underestimate surgery time by about a third. Therefore, discontinuing anesthesia coverage at a prespecified time may result in unexpected out-of-pocket costs for patients.
ASA President Donald Arnold said in a statement that the policy was a “cynical money grab by Anthem”.
Elevance argued that the policy is a safeguard against overbilling for anesthesia providers and is consistent with standard coding requirements.
A spokesperson for the insurance company did not respond to questions about evidence of overcharging in New York, Connecticut and Missouri or the specific misinformation that led Anthem to reverse the policy change. .
Elevance's policy shift also follows politicians in New York and Connecticut who have expressed opposition to the cap.
Citing the need to contain ever-increasing health care costs, insurance companies frequently turn to medical management practices such as restrictive coverage policies and prior authorizations to combat fraud, abuse, and unnecessary medical costs. I am. However, both companies have come under increasing criticism for tactics that delay or deny medical care to members in order to boost profits.
From 2022 to 2023, medical claim denials increased by an average of 20.2% for commercial insurance claims and 55.7% for Medicare Advantage claims, according to September data from the American Hospital Association. Many such denials are later overturned on appeal.
