Elevance has scrapped a controversial plan to enact time limits on anesthesia coverage for certain surgeries, following public outcry and opposition from physician groups.
The policy change was slated to go into effect in February for members of Anthem Blue Cross Blue Shield in New York, Connecticut and Missouri. The news flew under the radar after being announced last month, but roared back into the public sphere on Wednesday after UnitedHealthcare CEO Brian Thompson was shot and killed in New York City. The executive’s death sparked waves of anti-health insurer sentiment online.
“There has been significant widespread misinformation about an update to our anesthesiology policy,” an Elevance spokesperson said in an email sent to Healthcare Dive on Thursday. “As a result, we have decided to not proceed with this policy change.”
The spokesperson said that “it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
According to an Anthem provider newsletter, the insurer planned to use Physician Work Time values set by the CMS as the basis for anesthesia coverage. Any claims submitted for services that took longer than those set minutes would be denied. People under 22 and maternity care would have been exempt from the policy.
The American Society of Anesthesiologists railed against the change, arguing tying anesthesia coverage to CMS estimates of how long a service should take is “not an accepted, reliable, or rational method for payment” in a letter to Elevance CEO Gail Boudreaux. Elevance is the parent company of Anthem-branded plans.
“The CMS Physician Work Time was not developed nor intended to support reporting or payment for anesthesia services,” the ASA wrote in the letter dated November 12.
Typically, there is no set time limit on reimbursement for anesthesia. Instead, the pain management treatment extends as long as a physician requires to perform a surgery or other healthcare service. That’s important, as the duration of a surgery may be extended if medical complications arise, the ASA said.
Doctors underestimate the duration of a surgery roughly one-third of the time, according to a study published last year. As such, cutting off anesthesia coverage at a pre-specified time could saddle patients with unexpected out-of-pocket costs.
The policy is a “cynical money grab by Anthem,” ASA President Donald Arnold said in a statement.
Elevance defended the policy as a safeguard against anesthesia provider overbilling, and consistent with standard coding requirements.
The insurer’s spokesperson did not respond to questions about evidence of overbilling in New York, Connecticut and Missouri, or what specific misinformation was leading Anthem to revoke the policy change.
Elevance’s about-face on the policy also followed politicians in New York and Connecticut who expressed opposition to the caps.
Insurers frequently turn to medical management practices like restrictive coverage policies or prior authorization to combat fraud, abuse and unnecessary healthcare spending, citing the need to curb ever-rising medical costs. However, the companies are facing mounting criticism for allegedly using the tactics to delay and deny medical care for their members in a bid to boost profits.
Between 2022 and 2023, care denials increased an average of 20.2% for commercial claims and 55.7% for Medicare Advantage claims, according to American Hospital Association data from September. Many such denials are later overturned on appeal.