Anthem Blue Cross and Blue Shield will no longer be implementing a proposed new policy in Connecticut that would have seen the insurer deny claims for anesthetic services if they went over a set length of time. Comptroller Sean Scanlon recently announced that his office had spoken with Anthem, leading the insurer to reverse the policy.
“After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I’m pleased to share this policy will no longer be going into effect here in Connecticut,” Scanlon said via emailed press release.
According to the Connecticut Insurance Commissioner’s office, the changes would not have gone into place in the state due to existing contracts with providers.
“Anthem has informed the Insurance Department that while the billing change for anesthesiologists would not have applied in Connecticut due to contracts with providers already in place, the company has decided not to proceed with the policy rollout in other states have well.” insurance commissioner Andrew Mais told Inside investigator.
“While this is good news for Connecticut consumers, the Department is disappointed that our citizens were unnecessarily alarmed.” Mais added.
Mais’ office also shared the following statement Anthem provided to the insurance department:
“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 announced in November the company intended to change how insurance claims for anesthesia in Connecticut were handled, basing coverage on how long anesthesia is used rather than on a procedure, and using the Center for Medicare and Medicaid Services Physician Work Time values. The values take into account factors like the amount of work a doctor has to do, practice expenses, and liability insurance to set rates for how much doctors should be paid for different medical services, to “target the number of minutes reported for anesthesia services.”
“Claims submitted with reported time above the established number of minutes will be denied.” Anthem wrote in an announcement of the new policy.
There were exceptions to the proposed rule for patients under the age of 22 and for maternity-related care.
Broadly, anesthesia is billed by adding the number of anesthetic base units needed for a procedure to the amount of time a procedure takes. Payment varies depending on whether the payer is a government program like Medicare or a commercial health insurance program.
According to the American Society of Anesthesiologists (ASA), while staffing also affects Medicare payments for anesthesia services, most commercial plans are based on a single anesthesia clinician. Anthem’s announcement of the change in policy noted that industry-standard cording requirements and the ASA’s anesthesia formula will not be affected.
The ASA had called on Anthem to immediately reverse the change. A press release opposing the change stated that anesthesia service payments are based on several factors “including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards.”
“If an anesthesiologist submits a bill where the actual time of care is longer than Anthem’s limit, Anthem will deny payment for the anesthesiologist’s care. 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.” the ASA said in a press release.
ASA president Donald Arnold called the move “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.”
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Everything linked except this alleged press release from Scanlon? Where’s that? And what about New York and Missouri??