In a move that is stirring up frustration and concern, Anthem Blue Cross Blue Shield has announced a new policy capping anesthesia coverage that could lead patients in New York State, Missouri, and Connecticut to dig deeper into their pockets to cover medical bills. Starting February 1, 2025, Anthem will stop covering anesthesia services beyond a predetermined time threshold, according to NBC New York.
Details of the policy stipulate that anesthesia care duration will now be guided by the CMS Physician Work Time values, and services that exceed this duration will not be covered by Anthem; this new approach by the insurer means, if a surgery runs longer than their set limits, which they have not publicly disclosed, patients will be left handling what could potentially be sizable out-of-pocket payments, as reported by News 8.
Certain individuals will be exempt from this policy, including those under the age of 22 and those needing maternity-related care, as detailed by NBC New York. The American Society of Anesthesiologists has blasted Anthem's decision, stating "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," as obtained by NBC Connecticut from a statement.
Following the public outcry, Connecticut Senator Chris Murphy aired his indignation on social media, saying, "This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits? Reverse this decision immediately," as per NBC New York. While New York Governor Kathy Hochul pledged action on behalf of New Yorkers, stating via X, "Outrageous. I’m going to make sure New Yorkers are protected," as noted by News 8. The sense of urgency is palpable from these leaders as they respond to a policy perceived to prioritize profits over patient care; the backlash underscores the delicate balance insurers face between cost-containment and providing comprehensive coverage.
As the debate continues, Anthem's suggestion for policyholders is to file claim disputes should they disagree with a reimbursement decision. Meanwhile, the American Society of Anesthesiologists is urging those concerned to reach out to their state insurance commissioner or state legislator to express their concerns.
