CNN
—
After severe criticism from anesthesiologists, an insurance company has scrapped a plan to limit the length of time it will cover anesthesia used for surgeries and procedures. Anthem Blue Cross Blue Shield announced Thursday that it will no longer move forward with the policy change.
“Significant misinformation has been circulating regarding our hospital’s updated anesthesia policy. As a result, we have decided not to proceed with this policy change,” the company said in a statement. “To be clear, it has never been and will not be Anthem Blue Cross Blue Shield’s policy to not pay for medically necessary anesthesia services. Its sole purpose is to clarify the appropriateness of anesthesia consistent with guidelines.”
Anthem Blue Cross Blue Shield Insurance, which represents Connecticut, New York and Missouri, previously announced that starting in February it would deny claims for anesthesia services beyond certain deadlines set for surgeries and procedures. Ta.
Anthem said the changes are part of its efforts to make health care more affordable by reducing overbilling for anesthesia.
One of the leading expert groups for anesthetists said it was gross and ill-informed and called for the company to reverse what it called an “unprecedented move”.
“Anesthetists provide individualized care to all patients, carefully assessing a patient’s health status before surgery, examining pre-existing diseases and medical conditions to determine the resources and medical expertise needed, and providing Be present to the patient throughout, resolve any unforeseen complications that may arise, and/or extend the surgical time and ensure patient comfort during recovery,” the American Society of Anesthesiologists said in a statement. mentioned in.
The company previously said its criteria for determining how long surgeries take are consistent with industry standards and a formula set by the American Society of Anesthesiologists. Obstetric care and pediatric services for patients under 22 years of age will be excluded from the changes.
Anesthesiologists said Anthem’s policy places a huge undue burden on health care providers and patients and reflects a major misunderstanding of how things work in the operating room.
Dr. Gordon Morewood, vice chair of the American Society of Anesthesiologists’ Economic Committee, recently participated in a meeting between the society and Anthem executives.
He tried to explain how experts bill for anesthesia work – one particular billing code can be used for almost 200 different procedures, leading to wide variations in the amount of time required for anesthesia. – said he tried to explain and learned that Anthem does not and does not audit claims. There is no evidence that there was a problem that needed to be fixed.
“It’s an ironic process, knowing that many claims won’t be paid, and then figuring out how to deny even more claims in the first place,” Morewood said.
It is very difficult for anesthesiologists to bill for unnecessary time, especially in an operating room environment where many detailed time stamps are recorded and with the help of automated electronic health records. experts say.
According to Dr. Rick Vann, additional anesthesia time is typically used for safe patient care, such as establishing a safe airway and addressing physiological changes that may occur with the surgery, such as changes in blood pressure or respiratory tract. It is said that it is related to securing the Mr. Pelt is a board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital.
Get CNN Health’s weekly newsletter
“This approach[by Anthem]reflects a significant lack of understanding of the anesthesiologist’s role as an integral member of the surgical care team in providing safe, high-quality care to patients.” he said. “While no anesthesiologist would intentionally compromise the care they provide, unreasonable time pressure inevitably increases the risk of adverse medical events and patient harm.”
Morewood, professor and chair of clinical anesthesiology at Temple University’s Lewis Katz School of Medicine, said anesthesiology is often a surgical patient’s greatest fear, and when you add uncertainty about insurance coverage, confidence can be compromised in a crisis. He said he felt threatened. Reassuring patients about insurance concerns can take away from time spent explaining the actual risks and benefits of medical care.
“In many cases, you meet your anesthesiologist on the day of your surgery, and yet this is the person you are literally trusting your life with. “We are responsible for continuing to exist on this planet. So it’s a very tense environment,” he said. “It’s completely unconscionable for an insurance company to say, ‘Your meter will run out in an hour and a half.'”
