Anthem Blue Cross Blue Shield has abandoned its controversial plan to limit anesthesia coverage based on procedure times in Connecticut, following widespread criticism from doctors, patients, and elected officials. The policy, initially set to take effect in February 2024, aimed to cap anesthesia coverage for surgeries exceeding specified time limits, sparking outrage from medical professionals and policymakers who warned of severe consequences for patient care.
The proposed policy would have relied on metrics from the Centers for Medicare and Medicaid Services (CMS) to set benchmarks for allowable anesthesia times. Surgeries exceeding these limits would leave patients responsible for the additional costs. Critics, including the American Society of Anesthesiologists (ASA), argued that such restrictions were arbitrary and failed to account for the complexities of individual cases.
"This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need," said ASA President Dr. Donald Arnold in a statement. He added that the policy would burden patients with potentially thousands of dollars in unexpected medical bills.
Connecticut Comptroller Sean Scanlon announced the reversal on social media, stating, "After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I'm pleased to share this policy will no longer be going into effect here in Connecticut."
While Anthem has withdrawn the policy in Connecticut, it remains unclear whether the insurer will proceed with the plan in other states, including New York and Missouri, where similar notices had been sent to providers. Anthem representatives did not immediately respond to requests for clarification.
The backlash intensified in recent weeks, fueled by public fears of patients being left mid-procedure due to coverage limits. Social media users and elected officials condemned the proposal, with some ridiculing the idea of patients "waking up in the middle of surgery."
Sen. Chris Murphy (D-Conn.) labeled the policy "appalling," accusing Anthem of prioritizing corporate profits over patient care. "Saddling patients with thousands of dollars in surprise additional medical debt-and for what? Just to boost corporate profits?" Murphy wrote on Twitter.
Anthem defended the proposed policy as a measure to address overbilling and rising healthcare costs. In a statement provided to FOX61, the company said, "Anthem strives to help make healthcare simpler and more affordable. One of the ways to achieve that goal is to help ensure that claims are accurately coded, and providers are reimbursed appropriately for the services they provide to members."
Despite this rationale, medical professionals emphasized that procedure times can vary due to unforeseen complications. Republican State Sen. Jeff Gordon, an oncologist and hematologist, warned in a letter to Anthem last month that the policy could lead to adverse patient outcomes. "This policy is contrary to providing good and safe medical care," Gordon wrote, highlighting scenarios where surgeries may take longer than expected to ensure patient safety.
The ASA called the plan a "cynical money grab" and noted that Anthem's parent company, Elevance Health, reported a 24.12% increase in net income to $2.3 billion as of June. Dr. Arnold accused the insurer of prioritizing profits at the expense of essential medical care.
Anthem's retreat in Connecticut follows similar resistance in New York, where Gov. Kathy Hochul called the policy "outrageous." New York State Sen. Mike Gianaris pledged to introduce legislation to block such practices, tweeting, "Does Anthem expect a patient to get up in the middle of a surgery and walk away?"
