Anthem Blue Cross Blue Shield Won't Pay for the Complete Duration of Anesthesia for Patients' Surgical Procedures

[Nevilledog]

https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures


Another Example of Insurers Putting Profits Over Patients

CHICAGO – In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes. The American Society of Anesthesiologists calls on Anthem to reverse this proposal immediately.

Anesthesiologists provide individualized care to every patient, carefully assessing the patient’s health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, resolving unexpected complications that may arise and/or extend the duration of the surgery, and working to ensure that the patient is comfortable during recovery.

Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards. With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem will deny payment for the anesthesiologist’s 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.

“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, M.D., FACHE, FASA. “It’s a cynical money grab by Anthem, 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.”

*snip*

Don't remember seeing this story in November. I'm guessing it resurfaced because of the insurance CEO being killed today.

[ZonkerHarris]

1. and people will still wonder why he was shot. Not me.

[OMGWTF]

2. United Healthcare denied more claims than any other insurer according to a chart I just saw on DU.

https://democraticunderground.com/?com=view_post&forum=1002&pid=19787949

I know someone who had a colonoscopy and woke up in the middle of it. Said it was the worst pain of their life. This is fking barbaric!!

[xmas74]

49. United denied my c section back in 2000

Is been in labor for 3 days, failure to progress and my blood pressure skyrocketed almost out of control. I had it done at 1:30 in the morning in a Saturday.

Two months later I received a letter from United rejecting payment because I didn't schedule the c section in advance.

[soandso]

54. Did you contest it?

What a bunch of bullshit!

After what happened today, I don't think I'd want to be an employee of a health insurance company.

[xmas74]

66. Yes, i did.

I lost. At the time they were getting away with denying claims left and right.

It took a few years but I paid it off.

[soandso]

86. What a bummer

and so much stress, as well as additional expense, when you'd just had a baby.

This shit has to change.

[TBF]

65. I had a similar situation in 2007 - UH didn't want to pay for the surgeon

who jumped in to perform the emergency c-section (baby was literally stuck). They argued they would only pay for the delivery doctor - that the surgeon ($25K fee) was not covered. My husband happens to be an attorney & was in the delivery room. They did call in a capable surgeon to deal with the situation and save both of us. In the end UH paid. But I would expect it's much more difficult for families who aren't trained in the law - we had no problem threatening to sue them.

[ChazInAz]

75. Happened to me.

Apparently the IV had slipped out of my vein. I wasn't in much pain, but I felt like I needed to cut a nuclear fart. Woozily, I mentioned this to the people shoving things into me. (Got a nice view on a TV screen of a place I'd never seen before.) The comment caused some alarm, and corrective measures were taken.

[Demobrat]

15. I have a friend that works there

He says there’s a contingent insisting his wife paid for this.

[TBF]

31. Good lord -

somehow women will always be blamed.

[soandso]

41. In any murder

a spouse will be looked at and for spouses to kill spouses isn't unusual. Maybe the employees know something about their relationship. Maybe not.

[TBF]

64. I suppose so -

in this case, given victim's profession, it wouldn't be the first place I'd look.

[soandso]

85. And it turns out you're right

with those bullet casing having the words inscribed on the them which happen to come from the title of a book about insurance companies denying claims. I also read that he and his wife have lived apart for some time so that may be where the employee speculation arose.

Sure is an interesting case.

[TBF]

90. Ah, interesting that they lived apart -

and that explains the rumor. I hadn't read that yet, but I haven't been seeking the stories out (read enough yesterday!).

[soandso]

92. When he was killed, yesterday

A comment from her said he was a wonderful father but nothing about "and husband", so I wondered. She also mentioned he'd been receiving threats and something about "lack of coverage".

[3Hotdogs]

29. I gotta admit - it will tickle me if the shooter is a person whose claim was disavowed.

[allegorical oracle]

81. General sentiment about this murder (not just on DU) is leaning toward possible

justifying the misdeed. If caught and tried, it causes me to wonder if they'll be able to find a jury that will indict the shooter.

And, if any good emerges, perhaps it will prompt insurance companies to wake up to how despised they are. (I would add most ALL insurance, not just health, is a scam.)

[Karasu]

48. Literally the only surprising thing about that entire incident was that it took this long for something like it to

Last edited Thu Dec 5, 2024, 06:26 AM - Edit history (1)

happen to a health insurance CEO and not a politician.

Frankly, I would 100% expect this to continue to happen until the health care system changes to one without a profit motive or the system/country collapses (and at this point, I know which one I'm betting on).

[TommyT139]

53. I've been wondering

...how long until some open carry red state husband with a wife in labor crisis doesn't insist on her getting the care she needs.

I vaguely recall a version of this being a movie plot a lot time ago -- but a father and son?

[Nigrum Cattus]

84. That's what I thought -

We are the only 1st world nation that doesn't have universal healthcare.
Single payer or whatever form of universal healthcare is less expensive
in every way. The congress is responsible for the fix we are in.

[Passages]

3. We allow our lawmakers to allow this to be a USA reality.

No one believes this is fair, no one.

[Coventina]

4. I predict more healthcare CEO shootings. n/t

[markodochartaigh]

25. I'm against both the death penalty and

gunning down people in the street.

I do predict, however, that if the killer is found and starts a GoFundMe for his defense, the amount received will dwarf the GDP of most countries.

[Omnipresent]

76. It would be a monumental sign of protest.

Driving the point home that denying claims will not be allowed.

[magicarpet]

5. What does this mean ? The patient,...

.... becomes alert and fully awake during brain surgery,... and is screaming in bloody pain.

The insurance company goes oh well,... we are after all entitled to a reasonable level of returns on our investments and profits. We owe that to our investors.

Boo-boos are supposed to be painful.
Now go pound sand.

[Bo Zarts]

12. Patient stays "under" during the surgery .. the "pain" comes afterward.

It reminds me of a Mad Magazine cartoon back in the late '50s or early '60s. The docs are all gathered around the patient's bed, and the poor guy has a horrible look of pain on his face. In his hands is the bill for the services rendered. The caption of the cartoon was "The Presenting of the Bill."

[enigmania]

23. Mad magazine was great back then.

[calimary]

40. Sure was! I looked forward to every issue.

I LOVED all the illustrations, even the little bitty ones on the outside corners of the pages. Just blew my mind.

[Prof. Toru Tanaka]

58. Would that have been "another ridiculous MAD fold-in"?

Going by your description, I thought of the fold-ins.

I had a subscription to MAD in the 1970s and I always looked forward to receiving each issue.

[Demobrat]

16. It means the anesthesiologist does their job

and the insurance company refuses to pay them.

[soandso]

42. Actually, a lot of brain surgery is done w/o anesthesia

Seriously. Ain't that some stuff? I guess the brain doesn't feel anything and the patient gets a local in the scalp.

Anyway, this is is flat out insane. Only the doctors can stop this shit.

[colorado_ufo]

82. True dat.

I used to work in surgery decades ago, and there are no pain receptors in the brain. Patients were awake and in no discomfort. it is often necessary to assess if the surgeon is in the correct area.

[Hekate]

6. In the 1970s my dad needed a heart valve. Estimated time of surgery: 3 to 4 hours. Actual time: 12 hours

Ponder that.

This is horrifying. I guess “drive-thru mastectomies” and “drive-thru births” just didn’t give their shareholders enough warm fuzzies.

[nilram]

19. And if mine takes only 2 hours, they will pay me?

hahahahahahaha, I crack myself up.

[soandso]

43. Excellent point!

[Silent Type]

7. This sounds essentially like the way original Medicare pays for hospital stays and bundled care.

When someone covered by Medicare goes into the hospital, Medicare will pay a set rate for the diagnosis, even if care takes several days more than expected. The hospital either absorbs it or files an appeal documenting the set rate was not enough because of complications, etc.


Besides-- Medicare and others are headed toward these payment models--

Medicare's bundled payment model, also known as episode-based payment (EBP), groups all costs associated with a patient's care into a single payment. This includes the fees for surgeons and anesthesiologists, as well as staff, supply, and facility costs. The goal of bundled payments is to improve the quality of care and patient experience while reducing costs.

[soandso]

44. Interesting

They probably did that after years of getting bilked by hospital administrations. This must also be why the hospital is so eager to kick the patient out.

[Silent Type]

69. Believe it or not, when Medicare first started, docs and hospitals were paid whatever they charged. Medicare learned

quickly that wasn't going to work because docs, hospitals and others caught on quickly that if they keep increasing their charges they'd get paid more.

In late 1970s and 1980s, Medicare reimbursement policies were changed to prevent the obvious greed. Medicaid and private insurers did the same.

[soandso]

89. That's the same that drove tuitions

Once payment was guaranteed, universities raised tuitions and salaries.

[Irish_Dem]

8. Surgeons will only take easy cases that can be done quickly.

It is a way to force surgeons to refuse to take complicated cases.
They just tell the patient there is nothing that can be done.

Because they know they won't get paid if they take too long.

Unless you can find a very gifted surgeon who can do the complicated surgery
quickly you are out of luck.

[lonely bird]

9. Destroy insurance companies

Health insurance is not insurance. It is a casino where you provide the money that the house uses. All they are doing is making bets.

[Joinfortmill]

10. Appalling.

[Lonestarblue]

11. We have a for-profit healthcare system. The only thing that matters is profits.

And Republicans keep voting for people who want to take their money but deny them healthcare. Nice racket when you can easily get away with it.

[markodochartaigh]

24. The US does not have a health care system.

The US has a profit making system which produces as much profit as possible while producing as little health care as possible as a byproduct.

[NBachers]

13. Hey, I've got a great idea . . .

[WhiskeyGrinder]

14. This is as much violence as someone shooting someone on the street.

[Demobrat]

17. More. This CEO died instantly.

Probably never knew what hit him. The patients to whom he denied care were not so lucky.

[orwell]

18. Only the beginning...

...now that the circus is coming to town.

Send in the Clowns...

[DeeDeeNY]

20. If anyone hasn't seen it, I recommend the movie Sicko

It didn't even deal with people who were uninsured. Only those who actually had health insurance. The level of cruelty exposed in the health care industry was scary.

[calimary]

21. O. M. G. !!!

[enigmania]

22. I confess to

harboring great animus towards scumbag CEOs and their ilk when I was a young man, as I watched manufacturing disappear and prices rose. Never acted on it, of course.

[70sEraVet]

26. Years ago, my wife had surgery and had been in the hospital for a few days.

Her doctor came in, examined her, and said, "Well, when I check on you tomorrow, if you are still recovering at this rate, I may just release you tomorrow."
He walked out, and ten minutes later he walked back in, looking embarrassed.
"Your insurance company said you're ready to go home today."

We only exist for the benefit of their profit margins.

[Seinan Sensei]

63. A wallet-biopsy is required before services can be rendered

[RandySF]

27. There could soon be another dead health care exec.

[Joe Nation]

28. Universal Healthcare!

Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
Universal Healthcare!
NOW!

[SheltieLover]

30. WTAF?????

[Evolve Dammit]

32. How many here remember when Blue Cross/ Blue Shield (later "Anthem") was NON-PROFIT? I do.

[Demobrat]

34. Blue Shield still is. According to them.

[Evolve Dammit]

71. Interesting. Wonder if they "spun off" as their own entity?

[Demobrat]

72. Depends on the state. Here in CA

Anthem Blue Cross and Blue Shield are separate companies.

[Evolve Dammit]

73. 60 minutes should do a piece on this. We the consumers have no f'in idea.

[IronLionZion]

80. Blue Cross Blue Shield is a nonprofit federation of companies

Anthem is a for profit company within that federation. Anthem has such a shitty reputation that they changed their name to Elevance Health 2 years ago.

[Evolve Dammit]

88. Interesting. Still Anthem in northeast and they suck. Had a big data breech in addition to crappy coverage and service.

Co-pays and deductibles go up every year. When will US get our act together? Not under newly elected admin that's for damn sure.

[NGeorgian]

33. More reason to avoid Medicare "DISadvantage".

[MistakenLamb]

35. glad my plan is based in Michigan

not a good sign though especially with the incoming administration

[Jeebo]

36. I have Anthem Blue Cross/Blue Shield.

And I live in Missouri. If I have to face surgery, I will have questions for the doctors.

— Ron

[xmas74]

47. Same

MO policy but my surgery I discuss below was done over the state line in KS.

[PufPuf23]

37. Health insurance in the USA is a financial scam.

The rich get richer at the cost of lives and quality of lives.

Rank and file medical professionals are worn to a nub.

[leftstreet]

38. DURec

[orion9941]

39. This is horrible!

As a teenager I had a car accident that shattered my pelvis and crushed my ribs.
I was in surgery for 16 hours. God bless the surgeons, nurses, and everyone else.
But if this was in place at my worst when I needed grace the most, my parents would have been bankrupt!

[soandso]

45. OMG

I can't imagine going through injuries like that. You're lucky to be alive. Crushed ribs = can't breath.

[xmas74]

46. That's frightening.

I had Anthem when I went in for a simple out patient removal of an ovarian cyst. The first incision made them realize immediately that it was bigger than they thought and it was cancer. Once they converted from a lapro to a fully open abdominal surgery is when they saw cancer also on the other ovary and in my uterus. They also discovered possibly decades of undiagnosed endometriosis all over the abdominal wall, kidneys,colon, and a vein. While scraping the endo they nicked a vein and I began to hemorrhage, needing several units of blood.

I'm telling this because my surgery went over by several hours. According to this policy I could be denied any more anesthesia after what was initially predicted to be no more than 40 minutes in and out. Can anyone imagine going through what I did without anesthesia?

People will die under this policy.

[RainCaster]

50. There's a reason that CEO was shot

That could be the first of many if decisions like this are allowed to stand. What an awful company.

[C Moon]

51. And the worst administration in the history of the U.S. will be looking into this come Jan. 20th.

Gee, I wonder what they will do.

[pfitz59]

52. I thought of the logical response

But deleted it.

[BlueWaveNeverEnd]

55. scary and insane

[soandso]

56. This is further reason to dump Advantage if you have it

What will happen is doctors will refuse to accept that crappy insurance.

[C Moon]

57. Great. :/ That's who we are insured through.

[soandso]

59. Looks like it just those three states

I would also expect those states governments are going to say hell no and this will go to court.

[moniss]

60. Several years ago during a colonoscopy

the anesthesiologist didn't keep me under for the whole procedure. (I'm not saying it was this but I'm just relaying what it is like to come to while a procedure is still taking place.) So the person doing the colonoscopy needed to snip some polyps to send for examination. That all took place with me being under enough to not be able to scream, open my eyes or move but I was conscious enough to feel every bit of it.

[NoMoreRepugs]

61. Emblematic of what's to come from corporate America with the lawless SlobFather in charge?

I think YES.

[Historic NY]

62. Anesthesiologists used to bill seperately from the surgery..

its was always fun to get an additional bill. I required an active monitoring for any surgery due to a low heart rate, in including colonoscopy. I'd make the bells and other alarms go off. After my recent death and rebirth the gave me a defibrillator pacemaker and raised my heart rate.

[Ms. Toad]

67. The issue is likely a bit more complex than just evil insurance companies.

A substantial number of anesthesiologists are out-of-network even when the hospital in which you are having surgery is in-network, so this may be a way of trying to rein in costs associated with the higher costs of care by an anesthesiologist.

When I was 5 months pregnant I had an emergency appendectomy. Insurance completely denied the claim by the anesthesiologist because they were out of network. They were eventually required to cover the costs - because the closest in-network anesthesiologist was 50 miles away. Not a good look to require a 5-month pregnant woman needing emergency surgery to research and find the only in-network anesthesiologist (and then to drive 50 miles to have surgery. (The anesthesia was complex, since they tried to operate with only an epidural to save my daughter from in-utero exposure to anesthesia. Unfortunately, they had to switch to anesthesia since there was too much pain associated with the surgery.)

I'm sure I'm not the only one who has successfully argued to get out-of-network anesthesia covered as in-network care, since most people are completely unaware that anesthesiologists are often not employed by the hospitals in which they work.

I'm not suggesting it is appropriate - just that there are reasons unique to anesthesiologists for special rules - and to some extent these rules are similar to the time limits insurance imposes, at least indirectly, on regular office visits (where payment is based on the time each kind of visit is allotted - and if the visit runs over (or the doctor chooses to schedule longer visits) there is no additional payment.

[Martin68]

68. Unconscionable.

Trump's win has given all the corrupt players in industry and politics permission to do whatever they want.

[Pacifist Patriot]

70. As someone who once woke up on the operating table, this is horrific!

Yes, I know this doesn't result in anesthesiologists setting a timer, it just triggered an unfortunate memory.

[orleans]

74. WAKE UP! we haven't completed the surgery but your knock out time has expired. sorry.

better luck next time.

blue cross SUCKS

[bmichaelh]

77. May not be limited to just Anthem

This may not be limited to just Anthem.

Some of the BCBS across state lines have similar, if not identical, policies.

For example, in 2021, I was undergoing lymphoma treatment.
The drug was denied due to 'eligible for stem cell transplant'
It was successfully appealed.

I did some research on the internet and found out this reasoning was also used in another Blue Cross & Blue Shield.

[Passages]

78. "Kill a man, and you are a murderer. Kill millions of men, and you are a conqueror." -- Jean Rostand

The debt forces many to make difficult sacrifices. Two-thirds of U.S. adults who've incurred health care debt who've had cancer themselves or in their family have cut spending on food, clothing or other household basics, according to a poll conducted by KFF for this project. One in 4 have declared bankruptcy or lost their home.

The financial stress from debt can hinder cancer patients' recovery and even hasten death, researchers have found.
https://www.npr.org/sections/health-shots/2022/06/16/1104969627/medical-debt-upended-their-lives-heres-what-it-took-from-them#:~:text=The%20debt%20forces%20many%20to,'%22


THE REMEDY IS UNIVERSAL HEALTHCARE

No one needs to justify a man's murder but we do need to fix our lawmakers' addiction to legal bribes. Overturning Citizens United must be front and center on our political platform.

[IronLionZion]

79. Payment is the most painful part of the American healthcare system

so insurance companies want us to feel the pain. Meanwhile their stocks and profits are doing great.

[Vinca]

83. So say you wake up and there's an hour to go on the abdominal surgery. Do they give you a bullet to bite on?

A stiff drink? Does Anthem Blue Cross Blue Shield have any helpful hints?????

[Buns_of_Fire]

87. Like the old long-distance operator: "Please deposit

$100 for the next five minutes."

[keithbvadu2]

91. Wakey, wakey! Do you have your credit card handy?

[keithbvadu2]

93. Anthem Blue Cross Blue Shield calls off surgery anesthesia cap

https://www.democraticunderground.com/100219792844