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An insurance company is ending the plan after criticism from anesthesiologists. limitation The amount of time covering anesthesia used in surgeries and procedures. Anthem said Blue Cross Blue Shield will no longer be moving forward with the policy change.
There is significant misinformation regarding the revision of our anesthesia policy. Therefore, we have decided not to continue with this policy change,” the company said in a statement. “To be clear, it has not been and will not be Anthem Blue Cross Blue Shield's policy to not pay for medically necessary anesthesia services. The proposed revisions to the guideline are intended only to clarify the appropriateness of anesthesia in accordance with well-established clinical guidelines.
Anthem Blue Cross Blue Shield, which represents Connecticut, New York and Missouri, said it previously denied requests for anesthesia services past certain deadlines for surgeries and procedures starting in February.
He said the anesthesia change is part of an effort to reduce excessive anesthesia charges and make health care more affordable.
Later Raise the alarm Of the proposed plan, a leading group of anesthesiology experts said Friday that it is “delighted that the deeply flawed policy proposal has reversed course on its request to not pay for anesthesia care if the surgery or procedure is arbitrary and capricious beyond the scheduled time.” Limit the amount of time the surgery takes.
“Anesthesiologists provide individual care to each patient, carefully assess the patient's health before the operation, look at existing diseases and medical conditions, allocate the necessary resources and medical personnel, visit the patient during the entire process, solve unexpected problems that may arise. and/or prolonging the duration of surgery and making the patient more comfortable during recovery,” according to the American Society of Anesthesiologists. press release.
The company previously said the criteria it uses to determine how long a surgery will last are consistent with industry standards and formulas set by the American Society of Anesthesiologists. Maternity care and pediatric services for patients under the age of 22 are excluded from the change.
Anesthesiologists say your policy adds too much pressure to providers and patients and shows a huge misunderstanding of how things work in the operating room.
Dr. Gordon Morewood, vice chairman of the American Society of Anesthesiologists' Economics Committee, recently participated in a meeting between the society and Anthem executives.
Experts tried to explain how anesthesia billing was done—one specific billing code could be used for nearly 200 different procedures, leading to significant variation in the amount of time required under anesthesia—and learned that Anthem did not and did not audit claims. I have no evidence that there is a problem that needs to be fixed.
“It's a great exercise in finding a way to deny a lot of claims in the first place, knowing that a number of those will simply fall through and never get paid,” Morewood said.
Experts say it will be extremely difficult for anesthesiologists to bill for unnecessary time, especially in the operating room, where more detailed time stamps are recorded, and with the help of electronic health records.
Any additional time under anesthesia is related to ensuring safe patient care, such as maintaining a secure airway, or responding to physiological changes that may occur as a result of the surgery, such as blood pressure or respiratory rate, said Dr. Rick Van Pelt, MD, of Birmingham Hospital in Alabama. University Board Certified Anesthesiologist and Chief Clinical Change Officer.
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“This approach (at Anthem) reflects a lack of understanding of the anesthesiologist's role as an integral member of the surgical care team in providing safe, high-quality care to patients,” he said. “While no anesthesiologist will deliberately compromise the care they provide, undue time pressure inevitably increases the risk of adverse medical events and patient harm.”
Anesthesia is often a major fear for surgical patients, and adding uncertainty to insurance coverage threatens confidence in a vulnerable time, said Morwood, also a professor of clinical anesthesiology at Temple University's Lewis Katz School of Medicine. Reassuring patients about insurance concerns can take time to explain the actual risks and benefits of medical care.
“On the day of surgery, you will meet with your anesthetist several times. And yet, this is someone you literally put your life in them. They are responsible for your continuance on this planet one hour two hours six hours later. So that's a very crowded area,” he said. “It's unconscionable for insurance companies to say, 'OK, the meter is going to expire in an hour and a half.'”