HARTFORD, Conn. — Facing mounting public pressure, Connecticut-based Anthem Insurance has reversed course on a controversial proposal that would have put a time limit on the coverage of anesthesia treatments during surgery.
FOX61's Matt Caron reported on Anthem's anticipated policy change in November, reporting that coverage of anesthesia would be capped at an arbitrary time limit, and patients would have to pay out of pocket for remaining anesthesia use.
State leaders and healthcare industry experts have lauded the coverage as a key reason for the change, which is a victory for patients and providers.
Doctors and state leaders said the initial report by FOX61 on Nov. 21 put the multi-billion-dollar insurance company under an uncomfortable microscope.
“This is cruel. This is profit driven. This is greed based,” said State Sen. Saud Anwar of the legislature’s public health and insurance committees.
Few people know how money and medicine mix better than Anwar. He is also a medical doctor.
“The fact that they are coming up with such a policy on their end tells us what kind of a company they are,” Anwar said.
Anthem’s controversial policy change would have cut off anesthesia coverage at an arbitrary time limit during surgery.
The company responded with an initial statement, gaslighting doctors and blaming them for inaccurate billing, saying the policy “identified additional ways to safeguard against potential anesthesia provider overbilling.”
Anwar responded, “For them to say that physicians are taking a longer time for surgeries is far from the reality.”
The policy changes sparked fear that surgeries would be rushed and providers would be incentivized to choose patients with a lower chance of surgical complications.
“This might even constitute an unfair insurance practices claim,” said Connecticut Attorney General William Tong in a video statement released Thursday. “So, we’re going to be looking into it. I’m reaching out to Anthem today and we are going to get to the bottom of it.”
Tong added, “So what does that mean? Are doctors going to be waking patients up in the middle of surgery or are they going to be rushing through surgery because they won’t get paid? And then on top of that there will be a surprise medical bill for patients after their surgery if the anesthesia goes on too long. Come on Anthem, you can do better than this.”
The issue also caught the attention of state leaders like Comptroller Sean Scanlon.
“My office was hearing from constituents all across Connecticut who were scared, concerned and outraged,” Scanlon said.
By Thursday afternoon, Anthem announced its decision not to move forward with implementing the policy in Connecticut.
“It applies to every single person in Connecticut whether they are on the state employee plan or whether they have a commercial plan through Anthem. At the end of the day they are not going to carry forward this policy and that’s a win for the state of Connecticut,” Scanlon said.
In recent weeks, Anthem has not only been criticized for their policy proposal on anesthesia, but for slashing reimbursement rates for special needs therapy providers like speech pathologists and occupational therapists, which have resulted in higher co-pays and reduced appointment time.
Gail Boudreaux, the CEO of Anthem’s parent company, Elevance Health, released a statement Wednesday that said, in part, "Leadership in healthcare is marked by dedication, compassion, and a profound commitment to improving lives."
Residents have voiced concerns that sentiment doesn’t reconcile with arbitrary anesthesia coverage cutoffs and slashing services for kids with special needs.
When asked why Anthem ultimately chose to reverse the anesthesia policy, the Director of Communications Stephanie DuBois responded, “There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change. To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
Although enough pressure was put on Anthem to force this change out of Connecticut, Anthem still has plans to move forward with limiting anesthesia coverage in other state’s including Missouri. The policy will kick in in February.
Connecticut Insurance Commissioner Andrew Mais released the following statement:
“Anthem has informed the Insurance Department that while the billing change for anesthesiologists would not have applied in Connecticut due to contracts with providers already in place, the company has decided to not to proceed with the policy rollout in other states as well. While this is good news for Connecticut consumers, the Department is disappointed that our citizens were unnecessarily alarmed. The Department's mission is to protect consumers and it expects carriers to communicate with clarity and accuracy with their providers and customers."
This is breaking news.
Matt Caron is a reporter at FOX61 News. He can be reached at mcaron@fox61.com. Follow him on Facebook, X and Instagram.
Leah Myers is a digital content producer at FOX61 News. She can be reached at LMyers@fox61.com.
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