Connecticut state senator Jeff Gordon, MD, addressed concerns over Anthem Blue Cross Blue Shield's new policy on anesthesia claims in a Nov. 20 letter to the insurer, according to a news release from Dr. Gordon's office.
On Nov. 1, Anthem Blue Cross Blue Shield Plans representing Connecticut, New York and Missouri announced a policy revision set to take effect Feb. 1, 2025. The change will impact anesthesia claims under CPT codes 00100 through 01999.
Under the new policy, Anthem BCBS will use CMS physician work time values to determine the allowable time for anesthesia services. Claims exceeding the predetermined time limits will be denied.
"I continue to press for answers to this significant, even detrimental, policy shift when it comes to patient care and outcomes," Dr. Gordon wrote. "As a medical doctor, I can provide many real-world examples that demonstrate how predetermined time limits for anesthesiology coverage are unreasonable. Each patient and surgery is unique. I will continue to advocate for patients and collaborate with my medical colleagues to address this situation."
Dr. Gordon has also requested a joint meeting with Anthem BCBS to discuss the policy.
"This policy is contrary to providing good and safe medical care for people in Connecticut and other states," Dr. Gordon continued. "It could result in avoidable adverse events or unnecessary poor outcomes. Why would Anthem BCBS pursue such a policy?"
The American Society of Anesthesiologists has strongly opposed the new policy.
In a statement released Nov. 14, the ASA called on Anthem BCBS to reverse its decision, emphasizing the individualized nature of anesthesia care. According to ASA, the new policy means that Anthem BCBS will "arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure," potentially denying payment to anesthesiologists for managing complex or prolonged cases.