Tick-Tock: Anthem Blue Cross Blue Shield’s Dangerous Anesthesia Policy
Anthem Blue Cross Blue Shield, part of the insurance giant that now calls itself Elevance, has taken another step to prioritize profits over patients. Starting February 1, 2025, Anthem’s plans in Connecticut, New York and Missouri will no longer cover anesthesia for the full length of certain surgeries if they exceed an arbitrary time limit set by the company.
The American Society of Anesthesiologists (ASA) has called this move what it is: “a cynical money grab” that disregards the real-life complexities of medical care. As ASA President Dr. Donald E. Arnold said in a statement, “It’s appalling behavior by commercial health insurers looking to drive up profits at the expense of patients and physicians providing essential care.”
Under Anthem’s new policy, if the time required for anesthesia exceeds a certain time limit, patients could be saddled with crushing out-of-pocket costs to ensure continuous care.
As Connecticut anesthesiologist Dr. Kenneth Stone pointed out in an interview with a Fox affiliate in the state, “There shouldn’t be an arbitrary cutoff.” Dr. Jonathan Gal of ASA echoed these concerns, adding, “They are prioritizing profits over medical care.”
Anthem insists its new guidelines are about curbing overbilling. “We identified additional ways to safeguard against potential anesthesia provider overbilling,” the company said in a statement. In response, the ASA said in a November 12 letter to Anthem executives that the company’s policy “threatens to deny claims where the anesthesia practice has accurately documented the time taken to perform the anesthesia service.”
Anthem’s parent, Elevance Health, a New York Stock Exchange company, reported a staggering 24.12% increase in net income year-over-year, reaching $2.3 billion in June 2024. One way to achieve that kind of profitable growth is through more aggressive use of what the industry calls “medical cost management,” which encompasses a broad range of tactics to reduce spending on care.
Anthem used the Center for Medicare and Medicaid Service’s Physician Work Time “values” to justify its new policy. The ASA countered that those values were “not developed nor intended to support reporting or payment for anesthesia services.” Anthem’s claim that the policy aligns with “industry standard coding requirements” is, as ASA puts it, “grossly inaccurate.”
Impact on Patients and Providers
Anthem’s policy doesn’t just affect patient safety. It also disrupts the doctor-patient relationship. Anesthesiologists will now have to navigate arbitrary limits imposed by a distant insurer rather than tailoring care to the unique needs of each patient in an Anthem health plan. As Dr. Stone noted, “When a patient needs surgery, it’s a scary time for them. There is no minor surgery from the perspective of a patient.”
Surgeries often run longer than expected due to unforeseen complications. A study published in the Journal of Medical Decision-Making found that surgeons underestimated surgery durations 32% of the time. Medical procedures exceeding their scheduled times – often due to patient-specific factors like excessive bleeding or complex anatomy and inefficiencies in operating room management – all contribute to patients requiring anesthesia longer.
Anthem’s new policy attracted the attention of Connecticut State Rep. Jeff Gordon, who is also a physician. Gordon warned that patients “may decide to delay or not do these types of surgeries and procedures out of concern for what those bills might be.”
The ASA has asked Anthem to “rescind this inappropriate and misguided policy change immediately.”
Anthem’s new anesthesia guidelines should be a wake-up call for all of us. This is not just about one company — it’s about a health care system that allows insurers to dictate medical decisions in pursuit of ever-higher profits. Over the past several years, big for-profit insurers have gotten bolder in their refusal to pay for needed medical care. If we don’t push back now, the next patient on the operating table being refused pain relief by their insurance company could be you or someone you love.
In the words of Dr. Gal, “In the moment, do no harm. We all took the Hippocratic oath.” It’s time Anthem lived by it, too.
I'm certainly not advocating murder in any way, but with that preface, it is probably not any big mystery as to why the CEO of United Health was shot yesterday. Apparently the bullet casings left at the scene were inscribed with three words: Defend, Deny, Depose. In time, we will probably have a definitive answer as to motive. But -- based on those three words, on the known ruthless denials of healthcare that are endemic to UHC (and other insurers), and in talking with friends/neighbors yesterday about this event -- every single one said that the first thing that came to mind was that the shooter was someone who lost a family member due to UHC's hardcore denial of services/treatments/claims/payments. Brian Thompson was obviously murdered quickly and "in cold blood." But there are other ways to extinguish a life, and denial of care is certainly one of them. If this was/is the case, the suspect list is going to be in the tens of thousands.
It is utterly psychopathic and ghoulish to put a time-limit on anesthesia. Just as ghoulish as cutting off cancer treatments, or needed heart-surgery, or physical therapy, or mental health counseling, or spinal injections, or kidney dialysis, or -- or -- or -- all of the procedures that The Big Five have algorithms to categorically and routinely deny. They are vultures feeding off the sick, the dying, even the dead. I will refrain from further comment, other than to say that there is an ironic, allegorical element to this particular assassination.
"Over the past several years, big for-profit insurers have gotten bolder in their refusal to pay for needed medical care. If we don’t push back now, the next patient on the operating table being refused pain relief by their insurance company could be you or someone you love." Any thoughts on what this pushback could look like to be effective? I am very interested in coordinating a collective effort.