ASA, AANA respond to Anthem BCBS’ reversal of controversial anesthesia policy

The American Society of Anesthesiologists and the American Association of Nurse Anesthesiology have both issued responses to Anthem Blue Cross Blue Shield’s recent reversal of a controversial anesthesia policy.

The policy update would have introduced a new reimbursement structure based on CMS physician work time values. Claims exceeding these predetermined time limits would have been denied. Initially announced on Nov. 1, the policy would have taken effect on Feb. 1, 2025, impacting anesthesia claims across Connecticut, New York and Missouri.

The ASA said it is pleased with the Anthem BCBS’ decision to reimburse its’ “deeply flawed policy proposal,” the society said in a statement shared with Becker’s, adding that it expects the decision to be permanent.

“ASA and other surgical safety advocates were instrumental in notifying the public, patients and healthcare colleagues of Anthem’s proposed policy on physician payment and strongly called for its reversal,” the statement said. “The now-rescinded policy was inconsistent with prevailing standards, regulations and billing norms, and revealed a diminished dedication to patient safety on the part of Anthem.”

The policy proposal reflects a larger trend among insurers to undercut anesthesia billing and payment norms, particularly for care provided in emergency situations, according to the ASA.

According to the statement, earlier this year, Anthem BCBS also withdrew payments for qualifying circumstances in several states. Additionally, Blue Cross Blue Shield discontinued payments for physical status modifiers in five states and Aetna followed suit.

The American Association of Nurse Anesthesiology echoed many of the ASA’s thoughts, adding that there is still more to do — citing Anthem BCBS’ reduction of QZ services performed by certified registered nurse anesthetists to 85% of the physician fee schedule beginning Nov. 1 for its health plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine.

“While this is a good first step, Anthem and other health insurers still have anesthesia policies that espouse blatant provider discrimination in the reimbursement for anesthesia services,” AANA President Jan Setnor, MSN, CRNA, said in a release. “These policies exacerbate provider shortages and impede access to timely, necessary healthcare services. They also have the potential to drive up costs and undermine access for patients.”

The AANA has also filed a petition with a U.S. district court compelling Xavier Beccera, Secretary of Health and Human Services, to enforce the provider non-discrimination provision of the Affordable Care Act against insurance companies and health plans.

The non-discrimination provision was passed in 2010 to prohibit commercial payers from discriminating against providers on the basis of licensure, including setting up different reimbursement policies for those providers delivering the same high-quality healthcare services.

In 2020, the No Surprises Act required HHS to enforce policies within one year, but according to the AANA, there is still no enforcement in place for the non-discrimination provision.

“While we appreciate Anthem doing the right thing, we call on Anthem and other commercial payers to reverse course on these other discriminatory policies immediately,” Ms. Setnor said. “We also call on HHS to enforce the provider nondiscrimination provision of the ACA. Enforcement is crucial to protect patients’ access to care and help lower healthcare costs.”