Anthem Scraps Controversial Policy Following Backlash from Critics

Anthem Blue Cross Blue Shield has withdrawn a controversial anesthesia reimbursement policy after facing significant opposition from medical professionals and government officials.

At a Glance

Anthem BCBS reversed a policy that would have limited anesthesia reimbursements in three states
The American Society of Anesthesiologists strongly opposed the policy, citing patient safety concerns
Government officials, including New York Governor Kathy Hochul, intervened to oppose the policy
Anthem cited “widespread misinformation” as the reason for not proceeding with the policy change

Anthem Reverses Course on Controversial Anesthesia Policy

In a surprising turn of events, Anthem Blue Cross Blue Shield has decided not to implement a contentious policy that would have placed restrictions on anesthesia reimbursements. The proposed change, which was set to affect Connecticut, New York, and Missouri starting in February, sparked outrage among medical professionals and caught the attention of government officials.

The policy would have capped anesthesia coverage based on pre-set time limits, potentially leaving patients uncovered if procedures ran longer than expected. This move was met with fierce opposition, particularly from the American Society of Anesthesiologists (ASA), who argued that such restrictions could compromise patient safety and quality of care.

Opposition from Medical Professionals and Government Officials

The ASA took a strong stance against the proposed policy, highlighting the potential risks to patient care. In a statement, the organization said, “In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York, and Missouri have unilaterally declared it 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.”

“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care. It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care.” – ASA president Donald E. Arnold

Government officials also weighed in on the matter, with New York Governor Kathy Hochul taking a leading role in opposing the policy. After successful negotiations, Hochul announced the reversal of the policy, stating, “We pushed Anthem to reverse course, and today they will be announcing a full reversal of this misguided policy.”

Anthem’s Response and Policy Withdrawal

Facing mounting pressure, Anthem Blue Cross Blue Shield decided to withdraw the proposed policy change. In a statement, the company cited “significant widespread misinformation” as the reason for their decision not to proceed with the policy implementation.

“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change. 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. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.” – Anthem

Anthem emphasized that they never intended to deny reimbursement for medically necessary anesthesia services. The company stated that the policy was meant to align with clinical guidelines and prevent potential overbilling by anesthesia providers.

Implications and Future Considerations

The controversy surrounding Anthem’s proposed anesthesia policy has reignited discussions about the balance between cost-saving measures and quality patient care in the U.S. healthcare system. Critics argue that decisions affecting medical procedures should be determined by surgeons and anesthesiologists, not insurers.

In response to this incident, some lawmakers are taking proactive steps to prevent similar situations in the future. New York State Senate Deputy Majority Leader Michael Gianaris has announced plans to introduce legislation that would prohibit insurance companies from implementing such restrictive policies on anesthesia coverage.

As the healthcare landscape continues to evolve, the incident serves as a reminder of the ongoing challenges in balancing financial considerations with the imperative of providing high-quality patient care. It also highlights the power of collective action from medical professionals, government officials, and the public in shaping healthcare policies.