One day after Anthem Blue Cross Blue Shield came under fire for announcing that it was no longer covering anesthesia for entire lengths of surgeries for patients in Connecticut, Missouri, and New York, the health insurance provider reversed its decision to cap anesthesia.
RELATED: Blue Cross Blue Shield To No Longer Cover Anesthesia For Entire Length Of Surgeries In Connecticut, Missouri, And New York
As we previously shared, on November 1, Anthem Blue Cross Blue Shield 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).”
The statement continued, “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.”
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However, Anthem Blue Cross Blue Shield said there were at least two exclusions to the new impending rule: patients under the age of 22 and maternity-related care patients. Additionally, Anthem told policyholders that if they disagree with a reimbursement decision, they are more than welcome to file a claim dispute.
Speaking on the move, the American Society of Anesthesiologists condemned Anthem Blue Cross Blue Shield for trying to cap the amount of anesthesia allowed for patients in Connecticut, Missouri, and New York undergoing surgery. The organization slammed the insurance provider for screwing over patients by allowing them to undergo surgery, have their anesthesiologist submit a bill showing them receiving anesthesia past the pre-determined time limit, and then denying to pay them for it.
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After much backlash, Anthem Blue Cross Blue Shield has now reversed its decision to cap anesthesia coverage for patients in Connecticut, Missouri, and New York undergoing surgery.
In a statement to ABC News, the insurance company said, “There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change. To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
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