Anthem anesthesia payment policy reversal prompts statement from American Society of Anesthesiologists

Editor's Note

The American Society of Anesthesiologists (ASA) commended Anthem's reversal of a policy to deny anesthesia payment based on arbitrary time limits, which was set for February 2025 in three states. “The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of Anthem,” reads the December 6 statement from ASA.

Anthem’s proposed policy would have tied payments for anesthesia services to the duration of time a patient is under anesthesia. According to a December 5 article in the Associated Press (AP), the insurer’s reversal of this proposal followed significant criticism from medical professionals and the public, as well as intervention by state officials.  

Anthem stated that the policy aimed to align anesthesia services with clinical guidelines using "physician work time values" from the Centers for Medicare and Medicaid Services (CMS), AP reports. However, maternity patients and those under 22 were exempt from the policy. Critics, including the American Society for Anesthesiologists (ASA), argued the metrics were unclear and disregarded the complexity of surgical care.

Officials from Connecticut and New York confirmed they had engaged with Anthem to block the policy in their states, AP reports. The reversal came 1 day after the fatal shooting of UnitedHealthcare CEO Brian Thompson in New York. Anthem ultimately cited "significant widespread misinformation" as the reason for its reversal, pledging to continue covering medically necessary anesthesia services.

Although ASA applauded Anthem’s reversal, the organization emphasized that the company’s actions “reflects a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms that recognize anesthesia services and care, especially for care provided in emergency situations, to patients of extreme age and for more complex and vulnerable patients who require additional care from an anesthesiologist.” As examples, ASA cites  Anthem’s withdrawal of payments for qualifying circumstances and Blue Cross Blue Shield’s discontinued payments for physical status modifiers in several states.