The American Society of Anesthesiologists (ASA) is pleased that Anthem has reversed course on its deeply flawed policy proposal to no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary, Anthem-set time limit, regardless of how long the surgical procedure actually takes. Anthem was set to implement this policy on Feb. 1, 2025, in Connecticut, New York and Missouri. ASA and other surgical safety advocates were instrumental in notifying the public, patients and health care colleagues of Anthem’s proposed policy on physician payment and strongly called for its reversal. The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of Anthem.
Anesthesiologists provide individualized care to every patient, carefully assessing the patient’s health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, ensuring their safety, resolving unexpected complications that may arise and/or extend the duration of the surgery and working to ensure the patient is comfortable during recovery.
ASA expects the decision by Anthem to reverse its misguided policy will be permanent.
ASA welcomes Anthem’s decision but notes that Anthem’s recent policy proposal reflects a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms that recognize anesthesia services and care, especially for care provided in emergency situations, to patients of extreme age and for more complex and vulnerable patients who require additional care from an anesthesiologist. For example, earlier this year:
- Anthem withdrew payments for qualifying circumstances in several states.
- Blue Cross Blue Shield discontinued payments for physical status modifiers in five states and Aetna followed suit.
Physical status modifiers account for more intense services anesthesiologists provide to patients with different medical conditions and who require different levels of resources (e.g., medications, monitoring, testing).
These insurance policy decisions targeting anesthesiologists and anesthesia services provided to patients are not cost-saving solutions. Rather, they serve to shift costs from the insurers to hospitals, physicians, and patients.
Anesthesiologists have a unique understanding of medical science, deep personal experience in the delivery of health care, and an ethical duty to care for their patients. These factors invoke both a moral and a professional obligation on the part of anesthesiologists to help shape how the health care system functions.
ASA is committed to protecting patient access to care, ensuring accountability among insurers, promoting transparency in health care cost savings and advocating for fair and appropriate payment for anesthesiologists.