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Anesthesiologists are warning about an insurance company's plan. limitation Time to cover the anesthesia used in surgeries and procedures. A leading group of anesthesiologists is calling for an immediate reversal of the “unprecedented move” that is cruel and ill-founded.
Beginning in February, Anthem Blue Cross Blue Shield Insurance, which represents Connecticut, New York and Missouri, will deny any anesthesia services beyond certain time limits for surgeries and procedures.
Anthem said the change is part of an effort to make health care more affordable by reducing anesthesia fees.
“At Anthem, we strive to make healthcare easier and more affordable,” the company said in an email to . “One way to achieve that goal is to ensure that claims are handled properly, and providers are properly paid for the services they provide to members. Improper coding makes health care costs even higher, if not higher.
The company says the standards it's using to determine how long an operation will last are consistent with industry standards and formulas set by the American Society of Anesthesiologists. Maternal care and pediatric care for patients under 22 years of age are excluded from this change, as there is more flexibility in the time required for surgery and procedures for these groups, Antim.
But the American Society of Anesthesiologists has called for an immediate reversal of this policy, saying Antime has imposed an “arbitrary time limit” on surgeries that threaten individual patient care.
“Under this new policy, Anthem will no longer pay anesthetists to provide safe and effective anesthesia care to patients who require additional attention because of difficult, unusual, or complex surgery,” the organization said in a statement. News release.
Anesthesiologists say your new policy reflects a huge misunderstanding of how things work in the operating room and adds a tremendous amount of unnecessary pressure to providers and patients.
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 works—a specific billing code can be used for nearly 200 different procedures, resulting in a large variance in the amount of time required under anesthesia—and learned that Anthem did not and does 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 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 surgery, such as changes in blood pressure or respiration, said Dr. Rick Van Pelt, MD, on the board at the University of Alabama at Birmingham Hospital. Certified Anesthesiologist and Chief Clinical Change Officer.
“This approach (at Anthem) reflects a lack of deep 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 deliberately compromises 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 anesthesia 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.
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“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 existence 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.'”
For surgeries and procedures that take longer than Anthem has prepared, providers can file claims. But that adds more burden to the “army of people” working for providers to manage the “paper war” with insurance companies, Morewood said — and the added burden will impact health care costs as they try to reduce anesthesia time. .
“Health care delivery has many opportunities for improvement in terms of quality, safety and efficiency. The care environment is complex and there is a lack of comprehensive understanding of the interconnected systems that contribute to the problem, Van Pelt said. “Or efficiency cannot be solved by dealing with any single entity, and we know that going faster is not a sustainable solution.”