Doctors are raising alarm about insurance company’s plan to put time limit on coverage for anesthesia during surgery

Anesthesiologists are raising alarm about an insurance company’s plan to limit the amount time they cover for anesthesia used in surgeries and procedures. One major professional group of anesthesiologists is calling for immediate reversal of the “unprecedented move,” saying it’s egregious and uninformed.

Starting in February, Anthem Blue Cross Blue Shield insurance representing Connecticut, New York and Missouri will deny any claims for anesthesia services that exceed specific time limits that have been set for surgeries and procedures.

Anthem said the change is part of an effort to make health care more affordable by reducing overbilling for anesthesia.

The company said that the standards it’s using to determine how long a surgery should last are consistent with industry standards and formulas set by the American Society of Anesthesiologists. Maternity-related care and pediatric services for patients younger than 22 will be excluded from this change, as there is more variability in the time needed for surgeries and procedures for these groups, Anthem said.

But the American Society of Anesthesiologists has called for an immediate reversal of this policy, saying that Anthem has set an “arbitrary time limit” on surgeries that threatens individual patient care.

“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,” the organization said in a news release.

Anesthesiologists say that Anthem’s new policy reflects a great misunderstanding of how things work in the operating room and adds a significant amount of undue strain to providers and patients.

Dr. Gordon Morewood, vice chair for the American Society of Anesthesiologists’ Committee on Economics, recently participated in a meeting between the society and Anthem executives.

He said that experts tried to explain the way anesthesia billing works — that one specific billing code could be used for nearly 200 different procedures, leaving great variability in the amount of time needed under anesthesia — and learned that Anthem hadn’t audited claims and didn’t have any evidence that there was a problem that needed to be fixed.

“It’s a cynical exercise in figuring out a way to reject more claims initially, knowing that a number of those are just going to fall off and never be paid,” Morewood said.

It would be extremely difficult for anesthesiologists to bill for unnecessary time, especially in operating room settings where many detailed time stamps are recorded and with the help of automated electronic health records, experts say.

Any additional time under anesthesia is usually related to ensuring that patients are safely cared for, such as securing a safe airway, or responding to physiologic changes that may occur because of the surgery, such as blood pressure or respiratory changes, said Dr. Rick van Pelt, a board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital.

“This approach (by Anthem) reflects a profound lack of understanding of the role of the anesthesiologist in providing safe, high-quality care to patients as an integral member of the surgical care team,” he said. “While no anesthesiologist would intentionally compromise on the care they provide, it is inevitable that unwarranted time pressure will increase the risk of adverse medical events and patient harm.”

Anesthesiology is often a top fear for surgical patients and adding uncertainty around insurance coverage threatens trust in a vulnerable moment, said Morewood, who is also chair and professor of clinical anesthesiology at Temple University’s Lewis Katz School of Medicine. Reassuring patients about insurance concerns can take away from time spent explaining the risks and benefits of the actual medical care.

“Oftentimes you’re meeting your anesthesiologist on the day of surgery. And yet, this is someone in whom you are literally putting your life in their hands. They are responsible for your continued existence on this planet an hour, two hours, six hours from now. So that’s a very charged environment,” he said. “To have insurance companies saying, ‘Okay, the meter is going to run out after an hour and a half’ is just unconscionable.”

For surgeries and procedures that do require more time than Anthem has set, providers will be able to file a claim dispute. But that adds even more burden to the “army of people” who work for providers to handle the “paperwork war” with insurance companies, Morewood said – and that additional burden is more likely to affect health care costs that trying to trim down anesthesia times.

“Health care delivery has numerous opportunities for improvement in quality, safety, and efficiency. The care environment is complex and there is a general lack of understanding of the interconnected systems that contribute to the problem,” van Pelt said. “OR efficiency cannot be solved by addressing any single component, and we know that working faster is not a sustainable solution.”