How much does an hour of anesthesia cost? Blue Cross Blue Shield says it will work in other states
A new policy from the nation's largest insurers that would limit coverage for anesthesia claims is sparking widespread outrage from lawmakers and doctors.
Anthem Blue Cross Blue Shield plans to “close the case” to stop covering anesthesia claims for medical and surgical services that last “for a limited time,” according to the American Society of Anesthesiologists.
“This is the latest in a long line of appalling behavior by health insurance companies that want to increase their profits by paying patients and doctors who provide essential care,” said Dr. Donald E. Arnold, president of the group, in a statement. November's statement to the group. “It's an embezzlement by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with exceptional, comprehensive and safe anesthesia care.”
The policy change will take effect in Connecticut, New York, and Missouri, according to the group.
A note to Anthem New York providers says the policy will go into effect on February 1 in the state, and will base payment decisions on Centers for Medicare and Medicaid Services (CMS) Physician Work Time values, formulas that help determine government payments to physicians. .
“Claims with duration of anesthesia services that exceed the established limit will only pay the CMS established amount,” reads the provider's note. Patients under the age of 22 and those receiving maternity care are exempt.
Another provider note, reported by NPR, describes a similar policy that goes into effect in Colorado, starting in March.
The Independent Anthem has been contacted for comment.
New York Governor Kathy Hochul called the policy “outrageous,” while Senator Chris Murphy of Connecticut called it “horrendous” for X and warned that it would result in “shocking patients with thousands of dollars in additional medical bills.”
“And by whom? Just to increase the profit of the business?” he continued. “Withdraw this decision immediately.”
The policy will limit the installation of sensors to procedures that exceed the normal time limit (AFP via Getty Images)
Doctors, on the other hand, warned that the policy could affect care and does not count for many reasons surgery or a procedure that may take longer than the set formula.
“There are many real-world examples that I can provide as a physician that show that a predetermined time limit for anesthesia is unreasonable because there are so many other medical factors at play,” Jeff Gordon, a Republican state senator and physician. Connecticut, he wrote in a statement last month. “Each patient is different. Every operation is different.”
The average cost of anesthesia for an outpatient visit increased 20 percent between 2018 and 2022, to $989, according to the Health Care Cost Institute.
The company introduced the move as a way to reduce costs to patients by stopping claims.
“At Anthem, we strive to make healthcare simple and accessible,” the company told CNN. “One of the ways to achieve that goal is to help ensure that claims are filed accurately, and providers are properly reimbursed for the services they provide to members. Improper coding drives health care costs higher than they otherwise would be. “
Eric Levitz, a columnist for the progressive news site Vox, argues that there may be some policy flexibility, noting on the X site that “another way to consolidate payment rates for doctors making $400,00+ a year is to. everyone has to pay higher premiums to support their fraudulent charges.”
A heated public conversation about health care costs follows Wednesday's shooting of UnitedHealthcare CEO Brian Thompson outside a New York City hotel, in what police suspect was a targeted attack.
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