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

[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.