Anesthesiologists are sounding the alarm over a new policy by Anthem Blue Cross Blue Shield that limits the amount of time covered for anesthesia used in surgeries and procedures. Starting in February, the insurance company will deny claims for anesthesia services that exceed specific time limits set for surgeries and procedures in Connecticut, New York, and Missouri.
Anthem claims the change is part of an effort to make healthcare more affordable by reducing overbilling for anesthesia. However, the American Society of Anesthesiologists has called for an immediate reversal of the policy, saying it sets an “arbitrary time limit” on surgeries that threatens individual patient care.
Anesthesiologists argue that Anthem’s policy reflects a misunderstanding of how things work in the operating room and adds undue strain to providers and patients. They say that experts tried to explain the way anesthesia billing works to Anthem executives, but the company didn’t audit claims and didn’t have evidence that there was a problem that needed to be fixed.
The policy also raises concerns about patient care, as anesthesiologists say that any additional time under anesthesia is usually related to ensuring that patients are safely cared for. Adding uncertainty around insurance coverage threatens trust in a vulnerable moment, and reassuring patients about insurance concerns can take away from time spent explaining the risks and benefits of the actual medical care.
Providers will be able to file a claim dispute for surgeries and procedures that require more time than Anthem has set, but this adds even more burden to the “army of people” who work for providers to handle the “paperwork war” with insurance companies. Anesthesiologists say that healthcare delivery has numerous opportunities for improvement in quality, safety, and efficiency, and that working faster is not a sustainable solution.