Anthem Blue Cross Plans Won't Cover Anesthesia for Entire Length of Surgeries That Exceed Time Limit

[HereForTheParty]

Anthem Blue Cross Blue Shield's decision to cap anesthesia coverage based on arbitrary time limits has sparked outrage among medical professionals, who think "it's a cynical money grab" that prioritizes profits over patient safety.

In November 2024, the American Society of Anesthesiologists (ASA) sounded the alarm about Anthem's new policy which dictates that anesthesia services will only be covered up to pre-determined time limits. The complexity or duration of the surgery will not be taken into account, the ASA reported.

https://www.latintimes.com/plans-wont-cover-anesthesia-anthem-blue-cross-blue-shield-surgeries-567969

[greymattermom]

1. Ar what point is it

practicing medicine without a license? Also who decides how long a surgery lasts? Can't the times for all surgeries be increased by surgeons?

[Meowmee]

5. The insurance company will decide these things

Not the doctors etc. most of them ( the insurance etc. ) have no clue about anything about medicine. I will never forget my father arguing with someone from an insurance company, trying to explain to them why they had to do an a 4 vessel cerebral angiogram for my mother who had had a brain aneurysm bleed, they would only pay for one because they said the other three were unnecessary. In the end he somehow got it all paid for.

I suspect there may be successful lawsuits however if you stop giving someone anesthesia in the middle of a surgery. But what will really happen is that they’ll keep doing whatever they need to do and then you’ll end up with a huge bill, which will then have to be negotiated with the ins or the hospital or sue the insurance company for.

[dalton99a]

2. Nobody needs anesthesia during colonoscopies either

https://www.wbur.org/news/2024/01/24/blue-cross-pause-colonoscopy-anesthesia-sedation

Blue Cross halts controversial colonoscopy changes after backlash from doctors
Updated January 25, 2024
Priyanka Dayal McCluskey

Blue Cross Blue Shield of Massachusetts is putting the brakes on a controversial policy to restrict the use of anesthesia during colonoscopies.

The policy took effect Jan. 1, drawing outrage from doctors who worried it would slow their productivity and discourage patients from getting a potentially life-saving procedure over fears of discomfort and pain. Doctors had lobbied Blue Cross officials to reconsider the changes, WBUR reported earlier this month.

On Wednesday, Blue Cross leaders said they decided to pause enforcement of the policy — indefinitely.

“It has become clear to us that there is confusion about the policy and the reasons for it,” Dr. Sandhya Rao, the company’s chief medical officer, said in a statement.

[LW1977]

3. But their rich prick head CEO has a family..

Fuck these healthhcare companies!

[Ferryboat]

4. Might want to rethink this policy in light of the assassination of the CEO of UHC.

[FirstLight]

6. I'm not sayin' this should be the best form of "resistance"

Buuuut...there sure would be some "come to Jesus" moments if the Oligarchs started finding themselves being "weeded out" by meeting up with a guy named vinnie in a dark alley...

[Emile]

7. With the new justice system in America, the CEO's

of these Predatory insurance scams might want to hire 24 hour body guards.

[BannonsLiver]

8. For those confused by the reaction to the UHC ghoul's death

This is why some folks have little to no sympathy. Decades and decades of policies like this. It’s not complicated.

[bif]

9. Unbelievable.

[Silent Type]

10. That's not how I read Anthem's payment policy.

As I read Anthem’s new policy, Anthem is not going to automatically pay if the actual time exceeds the typical time. That does not mean they won’t pay, but they want to see documentation. Believe it or not, Anesthesiologists don’t always comply with time calculations, and sometimes their billing service -- that gets a percentage -- fudges.

Medicare has similar policies, we’ll pay for 12 Physical therapy encounters a year, one MRI for condition, 2 CBCs a year, etc. We’ll pay for more, but not simply became a doc submits a bill/claim. We want to see medical record justification before paying above guidelines. Medicare changes those polices often.

Won’t even get into anesthesiologists lobbying to make sure they get paid well while drinking coffee somewhere in the operative suite as four nurse anesthetists actually do the work.

[bif]

11. DUPE

https://www.democraticunderground.com/?com=view_post&forum=1002&pid=19788930