Anesthesia doctors were very critical of an insurance company’s plan to limit the amount of time it would pay for anesthesia used in surgeries and other treatments. The company has now dropped the plan. Thursday, Anthem Blue Cross Blue Shield said it would not go through with the policy change.
“A lot of people have been given false information about a change we made to our anesthesia policy.” The company said in a statement, “Because of this, we have decided not to go through with this policy change.” There was never a time when Anthem Blue Cross Blue Shield wouldn’t pay for medically necessary anesthesia services. That will never happen. The suggested change to the policy was only meant to make it clearer when anesthesia is appropriate based on well-established clinical guidelines.
Anthem Blue Cross Blue Shield, which covers people in Connecticut, New York, and Missouri, had said before that starting in February, it would not pay for any anesthesia services that were used after certain time limits for surgeries and treatments.
One large group of anesthesiologists told the company to undo what they called an “unprecedented move,” calling it outrageous and ill-informed.
According to a statement from the American Society of Anesthesiologists, anesthesiologists carefully evaluate each patient’s health before surgery, look at existing diseases and medical conditions to figure out what resources and medical expertise are needed, care for the patient during the entire procedure, deal with any unexpected complications that may arise and/or make the surgery last longer and work to make sure the patient is comfortable while they are recovering.
The company had said before that the rules it would use to figure out how long a surgery should last would be the same as those set by the American Society of Anesthesiologists for the medical field. Care related to pregnancy and juvenile services for people younger than 22 were not to be affected by the change.
Anesthesiologists said Anthem’s policy would have put a lot of extra stress on doctors and patients and showed a lack of understanding about how things work in the operating room.
Vice Chair of the American Society of Anesthesiologists’ Committee on Economics, Dr. Gordon Morewood, recently took part in a meeting between officials from the society and Anthem.
He said that experts tried to explain how anesthesia billing works and found that Anthem hadn’t checked claims and didn’t have any proof that there was a problem that needed to be fixed. One billing code could be used for almost 200 different procedures, which means that the amount of time needed under anesthesia could be very different.
“It’s a cynical exercise to figure out how to turn down more claims at first, knowing that some of them will just fall off and never be paid,” Morewood said.
Anesthesiologists would have a hard time billing for the time they didn’t spend doing their jobs, especially in the operating room where specific time stamps are used and electronic health records are used to keep track of everything.
According to Dr. Rick van Pelt, a board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital, any extra time spent under anesthesia is usually used to make sure that patients are safe, such as by making sure they have a safe airway, or to respond to changes in the patient’s body that may happen because of the surgery, such as changes in blood pressure or breathing.
“Anthem’s approach shows a deep lack of understanding of the anesthesiologist’s role in providing safe, high-quality care to patients as an important part of the surgical care team,” he said. “Anesthesiologists would never intentionally cut corners on the care they give, but being rushed for no reason will always raise the risk of bad medical outcomes and patient harm.”
Anesthesiology is often the thing that surgery patients are most afraid of, and not knowing if their insurance will cover it adds to that fear, according to Morewood, who is also chair and professor of clinical anesthesiology at Temple University’s Lewis Katz School of Medicine. It can take time away from talking about the risks and benefits of medical care to reassure people about their insurance.
“Most of the time, you meet your anesthesiologist the day of surgery.” Still, you are putting your life in the hands of this person. Because of them, you will still be alive in this world in an hour, two hours, or six hours. “So that’s a very tense place,” he said. The insurance companies telling people, ‘Okay, the meter will run out in an hour and a half,’ is so unfair.
Anthem said that the change was made to make health care more cheap by cutting down on overcharging for anesthesia.