Anthem Insurance in Missouri to limit anesthesia coverage after certain time limits

On December 5, 2024By Littum

KANSAS CITY, Mo. (KCTV) – In a move that is drawing sharp feedback from doctors, Anthem Insurance has decided to limit anesthesia coverage to a time limit.

The health insurance giant announced that the move would take effect on 1 February 2025.

“We will use the CMS Physician Work Time values to target the number of minutes reported for anesthesia services,” Anthem stated in a November announcement. “Claims submitted with reported time over the specified number of minutes will be rejected.”

The American Society of Anesthesiologists (ASA) rejected the move and asked the company to reverse course.

We question how Anthem could propose to pay for only a portion of the anesthesia service that their customers need. The policy does not envisage that an anesthetic code can apply to widely different surgical procedures with correspondingly large variations in surgical times. The policy also betrays a diminished dedication to patient agency and safety on Anthem’s part. In fact, if a patient has an operation that lasts longer than the standards accepted by Anthem, Anthem has relieved itself of the responsibility of paying for the anesthesia necessary for the rest of the encounter. Likewise, the policy does not take into account individual patient needs, which are embedded within the anesthesia time, including management of surgical complications during the procedure. Such complications are not incorporated into the base units awarded, but are accounted for and paid for under long-standing payment rules that incorporate time. The proposed Anthem policy reflects a significant disconnect between Anthem, its patients and their needs.

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The exclusions for the change are patients under the age of 22 and maternity-related care.

The ASA said it is encouraging those concerned about Anthem’s proposal to contact theirs state insurance commissioner or state legislature.

The policy will go into effect for Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri, according to the ASA.

Anthem stated that anyone who disagrees with a claim reimbursement decision must follow the claims dispute procedure outlined in their provider manual and that documentation is required to support such requests.

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