Anthem Reverses Policy Limiting Anesthesia Coverage Amid Backlash

On Thursday, December 5th, Anthem Blue Cross Blue Shield reversed a controversial policy that would have tied anesthesia reimbursement to predefined time limits following widespread criticism from medical professionals, lawmakers, and patients. The policy, set to begin in February 2025 in states including New York, Connecticut, and Missouri, was widely condemned as a threat to patient safety and a potential barrier to necessary medical care.

The American Society of Anesthesiologists and other medical professionals criticized the proposal for disregarding the unpredictable nature of surgery. Dr. Jonathan Gal, representing the society, called it “a blatant prioritization of profits over patient safety.” 

The insurance company announced plans to cap anesthesia to what was expectedly required for any given procedure, not covering additional anesthesia for procedures if there are unexpected complications, elongating the time procedures take. Anthem clarified that the policy was meant to align with clinical guidelines but acknowledged the backlash and rescinded it.

The decision to reverse came after interventions from public officials, including New York Governor Kathy Hochul. The New York Anthem Blue Cross office announced on December 1st that the anesthesia time billing policy would impact its New Yorkers enrolled with the insurance company. In a strongly worded statement, Hochul declared, “We pushed Anthem to reverse course, and today they will be announcing a full reversal of this misguided policy. Don’t mess with the health and well-being of New Yorkers—not on my watch.” Connecticut Comptroller Sean Scanlon similarly praised Anthem’s reversal, crediting public pressure and state advocacy for the change.

Anthem initially justified the policy by citing the need to control overbilling and planning to use metrics from the Centers for Medicare and Medicaid Services to calculate allowable time. However, critics argued that these metrics lacked transparency and failed to reflect the complexities of surgical procedures, including unprecedented complications. For example, breast reconstructive surgeon Dr. Dhivya Srinivasa noted that surgical duration often depends on factors beyond an anesthesiologist’s control, emphasizing the potential for undue patient risk.

Before its reversal, the policy provoked significant public outcry on social media and calls to state legislators, highlighting broader frustrations with insurance practices. The reversal marks a victory for patients and medical professionals advocating for policies that prioritize health outcomes over cost-cutting measures.

Notably, the reversal of the policy follows the recent killing of UnitedHealthcare CEO Brian Thompson on Wednesday, December 4th. Thompson was gunned down in broad daylight in Manhattan while on his way to an investors meeting. The assailant is still at large with the NYPD still investigating the motive. Three bullet shell casings were found at the scene Wednesday morning with the words “Deny,” “Defend,” and “Depose,” which echoes a 2010 book titled “Delay, Deny, Defend” which explains how insurance companies deny payments, services, and coverage. The industry standard for insurance claim denials is 16% of claims. UnitedHealthcare has the highest rate of claim denials at 32%. Speculation as to who the shooter is and what their motives were are fluid. 

The controversy underscores ongoing tensions between insurers and healthcare providers over cost management, with Anthem’s actions serving as a reminder of the importance of transparency and patient-centric care in medical policymaking. Governor Hochul’s firm stance reflects a broader push for accountability in the healthcare sector.