Here is a timeline of the controversy related to anesthesia reimbursement policies in the last six months:
1. Nov. 1, 2024: Anthem Blue Cross Blue Shield Plans, representing Connecticut, New York and Missouri announced changes to its evaluation process for claims for anesthesia services. The change would have gone into effect Feb. 1, 2025, and would have used the CMS physician work time values to identify the number of minutes reported for anesthesia services, and claims submitted with reported time over the set number of minutes would be denied.
2. Nov. 14, 2024: The American Society of Anesthesiologists called on Anthem BCBS to reverse its decision in a Nov. 14 statement shared with Becker’s. ASA said that anesthesia care is individualized to each patient and that, with this new policy, “Anthem will arbitrarily predetermine the time allowed for anesthesia care during a surgery or procedure,” and in turn, deny those physicians payment for “delivering safe and effective anesthesia care to patients … because their surgery is difficult, unusual or because a complication arises.”
“This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said Donald Arnold, MD, president of ASA. “It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care,” he added.
3. Dec. 4, 2024: Anthem faced scrutiny when posts about the policy went viral on X on Dec. 4, prompting policymakers to weigh in. In addition to the controversy the move sparked when it was released, outrage following the murder of UnitedHealthcare CEO Brian Thompson refocused attention on insurance decisions.
4. Dec. 5, 2024: Anthem BCBS reversed its decision on the anesthesia reimbursement policy change. The payer said that the reversal was spurred from “widespread misinformation” surrounding the update.
The change also came after policymakers in both Connecticut and New York expressed concern over the policy.
“Last night, I shared my outrage at a plan from Anthem to strip away coverage from New Yorkers who had to go under anesthesia for surgery,” Gov. Kathy Hochul said in a Dec. 5 statement shared with Becker’s. “We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy … Don’t mess with the health and well-being of New Yorkers — not on my watch.”
5. Dec. 12, 2024: Kaiser Foundation Health Plan reversed an anesthesia reimbursement change that it had implemented in Washington state in November.
Under the temporary changes, which took effect Nov. 1, Kaiser Foundation Health Plan of Washington and its subsidiary, Kaiser Foundation Health Plan of Washington Options, stopped reimbursing for anesthesia services for claims submitted without identifying who performed the service. In addition, reimbursement for services provided by a certified registered nurse anesthetist were lowered to 85% of the physician fee schedule.
On Dec. 12, a spokesperson for Oakland, Calif.-based Kaiser Permanente confirmed that it would reverse the policy.
“As one of the largest not-for-profit healthcare providers in the country, Kaiser Permanente’s mission is to provide high-quality, affordable care to our members and the communities we serve,” the spokesperson said. “While we will continue our focus on keeping care affordable for our members, we will not implement changes in reimbursement rates for anesthesia services provided by certified registered nurse anesthetists. We have returned to previous reimbursement rate levels, retroactive to Nov. 1, 2024.”
The change comes two days after AANA President Jan Setnor, MSN, CRNA, issued a public statement condemning the policy. Ms. Setnor argued that the policy would “devastate healthcare delivery” by impeding patients’ access to healthcare and represents the latest example of commercial payers making anesthesia reimbursement changes that conflict with the ACA’s federal provider nondiscrimination provision.
7. Jan. 17, 2025: Missouri lawmakers proposed a bill that would prevent insurers from restricting anesthesia coverage. Sponsored by Democratic Rep. David Smith, the bill directly responds to Anthem’s failed attempt to introduce time-based reimbursement caps.
8. Jan. 22, 2025: Illinois state Rep. Bill Hauter, MD, introduced a bill prohibiting insurers from setting time-based restrictions on anesthesia reimbursement. The legislation would grant the state’s Department of Insurance enforcement authority to penalize insurers attempting to impose such limits. The bill was passed unanimously out of the state insurance committee.
9. Feb. 5, 2025: State lawmakers in New Jersey introduced a bill to ban payers from placing time limits on anesthesia services. The bill was introduced by state Sen. Carmen Amato and Assemblymen Greg Myhre and Brian Rumpf.
10. Feb. 10, 2025: In a bipartisan bill, lawmakers in Washington state are taking steps to ban time caps on anesthesia coverage. The bill would immediately prevent any provider from attempting to deny coverage or cap reimbursement based on the duration of anesthesia used during a procedure.