Anthem drops anesthesia limit during surgeries in New York after outcry

A controversial plan by one of the nation’s largest insurance companies to limit coverage of anesthesia care during some surgeries in New York was halted Thursday after a wave of complaints.

The policy by Anthem Blue Cross Blue Shield was set to go into effect in February. The company said it would follow certain standards set by the federal Centers for Medicare & Medicaid Services to decide how many minutes it would pay for anesthesia during a procedure. It excluded maternity related care and surgeries on patients under the age of 22 from this limit.

Dr. Edward Rubin, a Garden City board certified anesthesiologist and pain management specialist, said the policy could have left patients with additional bills.

"Is there going to be pressure to rush a surgery based on these kind of payment policies?" Rubin, who is also treasurer of Nassau County Medical Society, asked before the policy reversal. "I don't think it's a good thing for patients at all to have an insurance company arbitrarily decide how long a surgery should take."

On Wednesday, Gov. Kathy Hochul responded on social media, calling the plan "outrageous" and pledged to "make sure New Yorkers are protected." By Thursday afternoon, she put out a statement saying her office had "pushed Anthem to reverse course" of the "misguided policy."

In a statement released Thursday afternoon, Anthem acknowledged it had dropped the policy change and pointed to "significant widespread misinformation."

"It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services," said Janey Kiryluik, staff vice president of corporate communications at Elevance Health, Anthem’s corporate name. "The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

Anthem on its website said it serves about 5 million members in New York.

The American Society of Anesthesiologists slammed the proposal last month, saying it would result in anesthesiologists not being paid 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."

Rubin said there are other ways for insurance companies to review concerns about costs without trying to determine how long surgeries should take.

"It's fair for them to look back and audit billing if they feel an anesthesiologist is somehow involved in billing excessive amounts of time," he said.

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.