Anthem Blue Cross Blue Shield, a major health insurer, on Thursday rolled back a policy change that would have capped payments for anesthesia for patients, and would have denied claims altogether if any given procedure exceeded a time limit.
The policy, which was to be tested before a national rollout, prompted controversy — first from anesthesiologists and then, after a flurry of media reports, from legislators in Connecticut and New York, where the policy was to go into effect in February.
Anesthesiologists said that the change in reimbursement was unprecedented and would have overturned a formula standard since the 1990s.
“No other commercial health insurer, no government payer, Medicare or Medicaid, has ever done anything like this and come up with an arbitrary time limit for anesthesia services,” Dr. Don Arnold, president of the American Society of Anesthesiologists, said.
“Surgery and other procedures can take variable lengths of time,” he added. “Certainly procedures and techniques are standardized, but patient needs are unique and they require variable amounts of time, care and attention.”
Gov. Kathy Hochul of New York wrote on X, formerly known as Twitter: “Outrageous. I’m going to make sure New Yorkers are protected.”
A spokeswoman for the insurer said on Thursday that the letters — to commercial providers on Nov. 1 and to Medicaid providers on Dec. 1 — misstated the planned policy change, and that it really “wasn’t a big deal.”
“We are not moving forward with the policy change because of the misinformation,” Janey Kiryluik, staff vice president for corporate communications with Elevance Health, Anthem’s parent company, said.
“We realized, based on all the feedback we’ve been receiving the last 24 hours, that our communication about the policy was unclear, which is why we’re pulling back.”
“Generally speaking, any medically necessary anesthesia, we will and always have and will pay for, even with this change,” Ms. Kiryluik added.
Even now, though, if an anesthesiologist bills for eight hours of services for a procedure that typically lasts four hours, she said, documentation would be required to support the charges: “We won’t automatically approve that.”
The company’s earlier letters to providers stated otherwise, saying that new time limits would be enforced.
The advice said that Anthem Blue Cross Blue Shield for New York, Connecticut and Missouri were changing how they evaluate claims for anesthesia services starting on Feb. 1, 2025.
The standard payment formula is based on medical codes indicating the type of care provided, as well as a time element, anesthesiologists said.
Those in private plans who reported times exceeding the average for a procedure would not be paid at all, Anthem said.
“Claims submitted with reported time above the established number of minutes will be denied,” the company’s letter said.
In a separate missive regarding Medicaid plans, Anthem said that claims for anesthesia services exceeding the set limits would be reimbursed only up to the limit, or preset average time for the procedure.
Anthem noted that the new limits would not be applied to maternity care or to pediatric patients 21 or younger.
