Anthem Insurance issues new edict to cap anesthesia coverage at a time limit

On November 14th, the American Society of Anesthesiologists put out this letter, sounding the alarm that Anthem suddenly decided to cap their coverage of anesthesia at an arbitrary time limit, a decision that doctors say isn't based on good medicine. There shouldn't be an arbitrary cutoff. Doctors across Connecticut and the country agree. They're prioritizing the profits over the medical care. Anthem's recent edict that they'll only pay for anesthesia up to a time limit is not only dangerous, but heartless. We have the patient's interest in mind. It would be nice if Anthem had the same perspective. And while doctors may not be waking patients up to ask them if they'd like to continue anesthesia, that means when they do wake up, they may be whacked with an out-of-pocket expense. There are circumstances where they won't pay for any of the anesthesia, even up to the point where they say it's justified. It's just absurd. We met anesthesiologist Dr. Ken Stone at St. Mary's Hospital in Waterbury. He's the calming last face a patient sees before falling asleep. He points out that the stress and nerves surrounding surgery shouldn't be compounded by a crippling financial uncertainty. When a patient needs surgery, it's a scary time for them. There is no minor surgery from the perspective of a patient. Doctors cite plenty of real-world examples of surgeries taking longer than expected. Blood loss, difficult anatomy, a complication or comorbidity. Medicine isn't one-size-fits-all. In the moment, you know, do no harm. We all took the Hippocratic oath. The American Society of Anesthesiologists has called on Anthem to immediately reverse the rule. Pretend like you have the CEO of Anthem in front of you right now. What do you say to that person? I start off with, what were you thinking and how dare you? Fox 61 asked Anthem to make an executive available for an interview. They didn't, but they did send us a statement that said in part, we identified additional ways to safeguard against potential anesthesia provider overbilling. And went on to say they are using the Center for Medicaid Services physician work time values to determine the appropriate number of minutes. Continuing that providers who go beyond the time limit can submit documentation for further review as part of a claim dispute. When we investigated Anthem in October, our report shined a light on the impact rate cuts had on special needs therapies. That's when state lawmakers started paying attention. My concern is that some patients may decide to delay or not do some of these types of surgeries and procedures of concern about what those bills might be. Not only is state Senator Jeff Gordon a lawmaker, he's also a physician. And now he's vowing to craft bipartisan legislation to put guardrails of accountability on Anthem. If these insurances have the light shined on them, so it's a more transparent process, you'll certainly hear from the medical community advocating for patient care. But you're also going to hear from the public who would be concerned about this. And that is a legitimate role of the state, I believe, for oversight. Anthem claims the policy change is an effort to make health care simpler and more affordable. They claim it will not apply to anesthesia providers in Connecticut for now, nor would it apply to maternal or pediatric care. Reporting in Wallingford, Matt Karan, Fox 61, Connecticut's news station.