Anyone with an Anthem Blue Cross Blue Shield plan in Connecticut, Missouri, or New York better pay attention because you’ll soon need to pay out of pocket for anesthesia if a surgery or procedure goes longer than expected.
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According to the American Society of Anesthesiologists, Anthem Blue Cross Blue Shield insurance can pre-determine the time allowed for anesthesia, and if an anesthesiologist sends through a bill showing that a patient was given anesthesia past that time limit, the company will deny paying for it.
It’s reported that on November 1, Anthem first announced its move to no longer cover anesthesia for the entire length of surgeries for patients in Connecticut, Missouri, and New York. The insurance provider said, “Beginning with claims processed on or after February 1, 2025, Anthem will change how it evaluates billed time on professional claims for anesthesia services (that is, CPT® codes 00100 through 01999).”
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They added, “We will utilize the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied. This update will not change industry standard coding requirements or the American Society of Anesthesiologists (ASA) anesthesia formula.”
The insurance provider also revealed two exclusions to this new rule: Patients under the age of 22 and maternity-related care patients. Additionally, Anthem said that policyholders can file a claim dispute if they disagree with a claim reimbursement decision.
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Speaking on the new policy, the American Society of Anesthesiologists said in a statement, “With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises.” The organization also said that concerned patients should contact their state insurance commissioner or state legislator.
Reacting to the news, Senator Chris Murphy tweeted on X, “This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits? Reverse this decision immediately.” Joining Murphy, New York Governor Kathy Hochul tweeted, “Outrageous. I’m going to make sure New Yorkers are protected.”
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