By New York Post (U.S.) | Created at 2024-12-05 18:46:28 | Updated at 2024-12-22 16:32:39
2 weeks ago
One of the largest health insurance companies in the US will start placing limits on the amount of time it covers for anesthesia while patients are under the knife — in a shocking move that physicians are calling “unprecedented.”
Starting in February, Anthem Blue Cross Blue Shield — which represents policyholders in New York, Connecticut and Missouri — says it will deny claims in which a patient was kept under anesthesia longer than the time it allots, depending on the procedure.
Under Anthem Blue Cross Blue Shield’s new rules, patients will receive an amount of anesthesia the company decides is appropriate. LIGHTFIELD STUDIOS – stock.adobe.com“We will utilize the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied,” the company wrote in a press release.
“This update will not change industry standard coding requirements or the American Society of Anesthesiologists’ (ASA) anesthesia formula,” Anthem claims.
The Nov. 1 announcement has drawn renewed interest following Wednesday’s murder of UnitedHealthcare CEO Brian Thompson, as new evidence suggests the shooter may have been motivated by anti-health insurance company sentiment.
The American Society of Anesthesiologists — a nearly 120-year-old organization representing 59,000 members — accused the insurance giant of putting “profits over patients,” and immediately called upon the insurance giant to reverse course.
“Anthem Blue Cross Blue Shield … 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,” the organization said in a press release.
The American Society of Anesthesiologists called the move “appalling” and implored the insurer to reverse course. jetcityimage – stock.adobe.com“With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises.”
Whereas medical services are typically charged on a per-procedure or per-appointment basis, anesthesiologists’ work is billed based on the exact amount of time a patient is under their care, which is carefully calibrated based on their exact medical needs, the ASA insists.
In a parting shot, the organization notes that Anthem Health “reported a 24.12% increase in its year-over-year net income to $2.3 billion and a 24.29% increase in its year-over-year net profit margin.”
The lone exclusions Anthem lays out for its draconian new policy are patients under 22 years of age or for anesthesia administered during maternity-related care.
Anthem did not immediately respond to a message from The Post seeking comment.
According to the company website, Anthem has nearly 6 million members in this area, including 4.8 million in New York and 1.1 million in Connecticut.
