Over one year after Anthem Blue Cross Blue Shield’s anesthesia time limit policy set off an industrywide backlash, the fight over how anesthesia care gets reimbursed is still unresolved.
A commentary published July 14 in the Journal of Clinical Medicine argues that the wave of state bans on insurer time caps has not addressed the underlying problem, which is that reimbursement is built around time as a stand-in for clinical value.
Here are 10 things to know.
1. On Nov. 1, 2024, Anthem Blue Cross Blue Shield announced a policy for Connecticut, New York and Missouri that would have used CMS physician work-time values to set minute-based thresholds for anesthesia claims, denying payment for care that ran longer than the benchmark. It was set to take effect Feb. 1, 2025.
2. The American Society of Anesthesiologists publicly opposed the policy on Nov. 14, 2024. Then-president Donald Arnold, MD, called it “a cynical money grab by Anthem, designed to take advantage of” anesthesiologists’ commitment to patient care.
3. The policy went viral on social media Dec. 4, 2024, drawing scrutiny from policymakers amid heightened attention to insurer practices following the killing of UnitedHealthcare CEO Brian Thompson.
4. Anthem reversed course the next day, citing “widespread misinformation” about the proposal. New York Gov. Kathy Hochul said she had “pushed Anthem to reverse course” on the “misguided policy.”
5. Kaiser Foundation Health Plan reversed a similar reimbursement restriction on certified registered nurse anesthetists in Washington on Dec. 12, 2024, restoring prior payment levels retroactive to Nov. 1.
6. Missouri, Illinois, New Jersey and Washington all introduced bills within about six weeks of the reversal, aimed at barring insurers from denying anesthesia claims based solely on preset time limits. Gov. JB Pritzker signed HB 1141 on Aug. 5, 2025, requiring insurers to cover medically necessary anesthesia for the full duration of a procedure, with medical necessity determined by the treating anesthesia provider.
7. Utah followed with the most recent ban. Senate Bill 50, signed into law in March 2026, prohibits insurers from denying payment for medically necessary anesthesia based solely on preset time limits, the reform the new commentary cites as evidence of “growing policy concern.”
8. Washington is still trying to close its own loophole. The state reintroduced House Bill 1812 in 2026, which would bar insurers from capping reimbursement based on the duration of medically necessary anesthesia care and add enforcement mechanisms for noncompliance.
9. The new commentary’s core argument is that these laws are a patch, not a fix. Authors of the commentary write that state bans stop insurers from denying claims outright, but leave intact a reimbursement architecture in which administratively derived time benchmarks, often built from claims data that can’t capture patient- or procedure-specific complexity, still drive payment and claims review.
11. Their proposed alternative is to pay for complexity rather than just minutes. The commentary points to a resource-based relative value system model, development that splits anesthesia payment into preoperative, intraoperative and postoperative phases rather than relying on elapsed time alone. Tested across 1,195 patients spanning ASA physical status classifications I through V, it produced commercial reimbursement just 3% below current payments ($1,082 vs. $1,114 per case) while Medicare payment rose 2.8 times for high-complexity cases and 3.6 times for critical-complexity cases. The authors also point to bundled, case-mix-adjusted payment models already used in the Netherlands, Sweden and Canada as proof that reimbursement can track patient acuity without relying on rigid time thresholds.
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