The insurance carrier, Blue Cross and Blue Shield (BCBS) had proposed to limit the cost of anesthesia for medical and surgical procedures. This proposal was to go into effect in New York, Connecticut, and Missouri. They announced this proposal the day the CEO of United Health Care was killed, on December 04, 2024. It was probably a test before it was to be rolled out nationwide.
“Blue Cross claimed the proposed update to the policy was designed to clarify appropriateness of anesthesia consistent with well-established clinical guidelines” (Fattah & Miller, 2024)
In plain language, a surgery procedure was scheduled for three hours, the procedure actually took four (4) hours. The insurance company would not pay for the fourth hour. This mandate would set the doctor’s reimbursement based on time limits set by the insurer (Fattah & Miller, 2024). Guess who would be responsible for the additional hour (s) of anesthesia?
Things happen in surgery. Unforeseen complications can occur due to the health of the patient, or the skill of the surgeon. Many things can occur.
“The American Society of Anesthesiologist and the Governor of New York , Kathy Hochul all spoke out against this policy” (Fattah and Miller, 2014).
The goal of a business is to make as much profit as possible for the shareholders. Insurance companies are seeking ways to cut costs and services to meet their bottom line. Putting profits over people in healthcare is a risky business. Stay informed and call the insurance commission in your state for additional information.
Reference:
Asahq.org. (2024). Anthem Blue Cross Blue Shield Won’t Pay in the Complete Duration of Anesthesia For Patient Surgical Procedures. American Society of Anesthesiologist (ASA).
Fattach, M and Miller, S (2024). NBCnews.com. Anthem Blue Cross Shield halts Anesthesia Payment Policy After Backlash.
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