Anthem Reverses Course on Anesthesia Time Limits

The nation’s second-largest health insurer, Anthem, has rescinded a controversial policy to pay for anesthesia only up to a certain time limit that sparked outrage among anesthesiology professionals and state officials.

The company announced November 1 it would deny claims for anesthesia that exceeded time limits set by the insurer, with exceptions for maternity care and patients younger than 22 years. The policy was set to begin February 1 for commercial plans and Medicaid managed care plans in Colorado, Connecticut, New York, and Missouri.

But after behind-the-scenes lobbying by anesthesiology groups and intense public criticism as news spread online this week, Anthem said Thursday it would no longer pursue the policy. The insurer serves about 46 million enrollees in its health plans and its parent company, Elevance Health, reported $170 billion in revenues in 2023.

“There has been significant widespread misinformation about an update to our anesthesia policy,” Elevance Health spokeswoman Janey Kiryluik told Medscape Medical News. “As a result, we have decided to not proceed with this policy change.” 

The reversal comes several weeks after officials from the American Society of Anesthesiologists (ASA) met briefly with Anthem.

At that time, the ASA position was “how dare you do this and stop,” Donald Arnold, MD, ASA president, told Medscape Medical News.

“It’s just another example of an insurance carrier trying to prioritize their profits over safe patient care,” said Jonathan Gal, MD, professor of anesthesiology, perioperative and pain medicine at Icahn School of Medicine at Mount Sinai, New York City. Gal chairs ASA’s Committee on Economics and attended the meeting.

Anthem’s policy reflected “a contractual dispute about how to pay for anesthesia that’s best left for actual contract negotiations. There you can argue about overbilling or, alternatively, beef up audits/checks,” Loren Adler, associate director of the Brookings Institution Center on Health Policy, Washington, DC, wrote on the social media platform Bluesky.

The Anthem policy would have created a new administrative burden on anesthesia groups to appeal with documentation every claim for a service that took longer than average, Adler continued, describing the policy as “annoying and unfair” to implement outside of Anthem’s contract negotiations with anesthesiology groups.

‘Illogical Policy’

Before Anthem announced a complete reversal, authorities in Connecticut said they had succeeded in overturning the anesthesia limits.

“This policy will no longer be going into effect here in Connecticut,” State Comptroller Sean Scanlon wrote on X.

Connecticut State Sen. Jeff Gordon, MD, a hematologist-oncologist, also pressured the insurer. In a letter to Anthem shared with Medscape Medical News, he wrote about his concerns for patient safety if anesthesiologists and surgeons had to choose whether to continue a procedure.

And US Sen. Chris Murphy (D) of Connecticut called the policy“appalling” on X. “Reverse this decision immediately,” he posted.

Kenneth Stone, MD, an ASA board member and Connecticut anesthesiologist, said the policy was illogical because anesthesiologists don’t control the duration of surgery.

“The case lasts as long as the surgeon needs to do the procedure,” he told Medscape Medical News,noting that the same procedure might take half an hour for one patient but 3 hours for another.

Even though Anthem said it would only apply the policy to the healthiest patients — those with an ASA Physical Status Score of 1 or 2 — it would still affect many procedures, Stone said.

“We’re very happy to have nipped this in the bud,” said Stone, adding that other large insurers might have followed Anthem’s example.

Arnold said that Anthem officials said the insurer was trying to combat over-billing by anesthesiologists. That also drew anesthesiologists’ ire.

The ASA president noted that the anesthesia start and stop times are almost always automatically recorded through the electronic medical record and then directly integrated into a hospital’s billing system.

“There’s not a lot of opportunity to get these things wrong,” he said.

Gary S. Schwartz, MD, vice chair of the Department of Pain and Anesthesiology at Maimonides Medical Center, Brooklyn, New York, said that everything in an electronic medical record is time-stamped. “The room for abuse is quite low,” Schwartz told Medscape Medical News.

He and other anesthesiologists said that Anthem had not provided any evidence of fraud or patient safety concerns.

As news of the policy circulated online, some took to the Reddit r/anesthesiology forum to express opinions and grim humor. “Sorry Becky, Sevo comes off 135 minutes post-incision. I don’t gas for free,” joked one user.

Another user asked if Anthem’s “plan is to have us hold the bag for a complicated surgery or a slow surgeon? yeah let’s see how this goes.”

Posters also made dark jokes referencing the December 4 fatal shooting of UnitedHealth CEO Brian Thompson in New York.

“Hope (Anthem’s) CEO looks over their shoulders when walking outside in the morning,” posted one user.

Stone said he believes the bad press and online discussions served a purpose.

Anthem officials “were publicly shamed,” he said. “It was an indefensible position.” 

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications, including JAMA and Smithsonian.com. You can find her on X @aliciaault.