It took a CEO's death to begin seeing critical conversations happening among healthcare coverage deciders. After backlash from doctors and patients, here's where Anthem has landed.
What This Week’s Blue Cross Blue Shield Health Insurance Announcement Means for You
Published on Dec. 06, 2024
It’s been a strange week for health insurance companies, starting with the December 2 New York City murder of United Healthcare CEO Brian Thompson—after which law enforcement officials confirmed that the words deny, defend, and depose were inscribed into the bullet casings. These words were an apparent reference to the tactics insurance companies use to deny health coverage to patients.
It wasn’t serendipitous timing that Monday, Anthem Blue Cross Blue Shield had announced a plan to, in the words of NBC News, “limit reimbursements for anesthesia during surgeries and medical procedures” in the event that a surgery or procedure surpasses a pre-established timeframe. As NPR reported, Anthem wrote the following in a December 1 notice to New York healthcare providers: “Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount.”
Anthem’s new policy was set to begin next year, and would have affected policyholders in at least three states: Connecticut, New York, and Missouri. The company also reportedly posted notices in Colorado and Virginia, suggesting broader plans to instate the policy.
By Thursday afternoon, the notice was retracted and removed from Anthem’s website.
The reversal came amid swift public backlash to the company’s initial announcement. The Joint Commission, an independent authority that accredits and oversees quality delivery of care across 22,000 hospitals per year, reports that nearly 40 million anesthetics are used in America annually. They’re typically administered by the patient’s doctor or an anesthesiologist, a doctor specially trained to deliver the anesthesia dosage based on the patient’s medical history, their individual health metrics, and the nature of the procedure. An anesthesiologist will also often supervise the patient’s state while “under.” The American Society of Anesthesiologists (ASA) says, “Anesthesiologists have 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training.” Anesthesia is used for life-saving and elective procedures that tend to be more invasive and therefore extraordinarily uncomfortable or painful in nature—from heart surgeries, organ transplants, maternity care, joint replacements, dental procedures, and much more.
By Thursday afternoon in an updated letter replacing the original notice, Anthem stated, […We] have decided to not proceed with this policy change.” They claimed that they never intended to deny coverage for cases in which prolonged anesthesia is medically necessary, and called the public’s reaction over their decision “misinterpretation of our policy change.” They further noted: “There has been significant widespread misinformation about an update to our anesthesia policy,” adding: “The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. Any medically necessary anesthesia would have been paid under the update. In circumstances when anesthesia providers went outside of well-established clinical guidelines they would have been able to submit medical documentation to support accurate payment.” Anthem added: “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services.”
Of course, submitting “medical documentation” puts even greater workload on doctors in an already-overworked profession with life-or-death stakes, not to mention that the question would come down to who deems the procedure “medically necessary”—a decision that almost inarguably should be determined exclusively by the physician providing the patient’s care.
As such, some doctors have been responding vocally. A November 14 news release penned by the American Society of Anesthesiologists, which appears to have been anticipating the impending Blue Cross Blue Shield policy change, called the decision “an unprecedented move,” “a cynical money grab,” and “another example of insurers putting profits over patients.” In that letter, the society called on Anthem to immediately reverse the policy proposal. “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 E. Arnold, MD, FACHE, FASA, who said the move was “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. This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need,” he added. “With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual, or because a complication arises,” they wrote.
The ASA added that this decision would “arbitrarily” establish a timeframe for covered procedures, ultimately undermining doctors’ ability to provide customized care based on patient needs.
The conversation comes amid an era when many patients and their providers feel healthcare costs and coverage are falling short in unprecedented ways. By Friday, even some doctors had taken to social media to raise consumer awareness of the issue, with Dr. Alan Nguyen, DO, posting on Instagram, “This physician’s appeal to United Healthcare to authorize anti-nausea/vomiting meds on behalf of a pediatric patient on chemo was denied. You don’t hate these insurance companies enough.” That’s just one of many anecdotes that’s come to light this week.
As some on social media are saying, Anthem’s about-face may be evidence that ongoing public outcry could finally start to make a difference.
In December 2023, the American Medical Association (AMA) listed the top 10 insurance companies by market share, in the following order:
- UnitedHealth Group
- Humana
- CVS (Aetna)
- Kaiser Permanente
- Elevance Health
- Centene Corp.
- Cigna
- Blue Cross Blue Shield of Michigan Highmark
- SCAN
Of these, Value Penguin calls Kaiser Permanente “the best overall” for 2025.
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