From reimbursement reforms to the No Surprises Act, a wave of new policies is shaping the future of anesthesia care in the U.S.
While some legislative efforts aim to protect anesthesia services and support equitable reimbursement, others have triggered backlash for undermining provider autonomy, patient safety considerations and fair payment.
Policies helping anesthesia providers:
1. Banning time limits on anesthesia reimbursements
Illinois recently took a stand against restrictive anesthesia billing practices. Gov. J.B. Pritzker signed legislation requiring insurers to cover anesthesia for the entirety of a procedure, banning time limits on reimbursement. The law was in direct response to Anthem Blue Cross Blue Shield’s now-withdrawn policy that sought to cap anesthesia coverage in several states.
Other states are following suit. In Washington, legislators proposed a bipartisan bill that would immediately prohibit insurers from denying coverage or capping reimbursement based on the duration of anesthesia.
2. Support for the No Surprises Enforcement Act
In July, major medical societies, including the American Society of Anesthesiologists, voiced support for the No Surprises Enforcement Act. The bill would penalize insurers who lowball initial payments and lose arbitration by requiring them to pay triple the difference, plus interest. This is intended to hold insurers accountable in the independent dispute resolution process, a key component of the No Surprises Act.
Policies hurting anesthesia providers:
1. Push for time-limited coverage in New York
Despite progress in some states, New York legislators added amendments to two bills that would allow insurers to predetermine allowable anesthesia durations. This directly undermines patient-specific care and has drawn concern from providers who fear it prioritizes insurer control over clinical judgment.
2. UnitedHealthcare’s reimbursement cuts and modifier removal
UnitedHealthcare’s July 1 policy update eliminated key physical status modifiers from its anesthesia reimbursement calculations. These modifiers account for the complexity of patient conditions, such as severe systemic disease or critical illness, and help reflect the increased risk and skill required during anesthesia.
The ASA criticized the change, stating it ignores the foundational principle of individualized patient care. ASA President Dr. Donald Arnold said “It’s shameful that insurers are padding their profits at the expense of payments for those providing important care to complicated patients.”
The update also removed payments for certain CPT code add-ons and included a 15% reimbursement cut for independently practicing certified registered nurse anesthetists, effective Oct. 1.
CRNA advocates have warned that this could result in delayed procedures, longer patient travel times, and worsened staffing shortages, particularly in rural and underserved areas.
AANA President Janet Setnor, CRNA, MSN, called the policy “discriminatory toward independent CRNAs” and said it “doesn’t benefit the patients.”
3. Independent dispute resolution challenges undermining provider leverage
Several legal decisions have tipped the scales in favor of insurers. In June, the 5th Circuit ruled that the No Surprises Act does not allow providers to enforce IDR outcomes in court unless there is fraud or misconduct. Third-party arbitrators were also granted immunity from lawsuits.
Additionally, Elevance Health, parent company of BCBS of Georgia, sued three medical organizations for allegedly exploiting the IDR process to secure inflated payments. These actions reflect mounting tension between payers and providers, and may discourage providers from fully utilizing dispute resolution tools.
