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These past few weeks, the U.S. healthcare system has been the focal point of heated coverage. United Healthcare’s CEO was shot around the same time Anthem announced a significant coverage change.
The frustration we have seen evoked intense pushback from patients and medical professionals alike in a moment of surprising unity. This recent episode brought Anthem Blue Cross Blue Shield (BCBS), one of the nation’s largest insurers, into the spotlight.
Following intense criticism from doctors, policymakers, and patients, Anthem almost immediately reversed a planned policy that would have capped reimbursement for anesthesia services based on pre-set time limits.
Typically, we do not cover political and news events, but in this case, we think they highlight what is driving burnout and frustration amongst physicians and the public with the American healthcare system.
We’ve been forced to ask ourselves a pertinent question: Who should dictate how medical care is provided — insurance companies or medical professionals? Before getting into that, let’s first get a breakdown of what caused Anthem’s sudden reversal.
Chain of Events
- November 2024 – Anthem Blue Cross Blue Shield announces a new reimbursement policy targeting anesthesia services, set to begin February 1, 2025, in Connecticut, New York, and Missouri.
- Mid-November 2024 – The American Society of Anesthesiologists (ASA) criticizes the policy as a “cynical money grab.” Further stating that the policy risks denying payment for necessary care, leaving patients with unexpected medical bills.
- December 2024 – The killing of UnitedHealth CEO Brian Thompson amplifies scrutiny of the health insurance industry, indirectly drawing attention to Anthem’s policy change. The public outcry against Anthem’s proposed policy intensifies as fears of rushed surgeries and inadequate coverage begin to escalate.
- In New York, Gov. Kathy Hochul denounces the policy as “misguided” and takes credit for pressuring Anthem to reverse it. While over in Connecticut, Comptroller Sean Scanlon confirms Anthem’s policy won’t take effect in the state after his office’s intervention.
- December 7, 2024 – Anthem announces it will not proceed with the policy change due to “significant widespread misinformation.” The company reaffirms its commitment to covering medically necessary anesthesia services, aligning with “well-established clinical guidelines.”
The Policy That Wasn’t
Last month, Anthem BCBS quietly announced a controversial update to its reimbursement policy for anesthesia services, targeting states like Connecticut, New York, and Missouri. This change would have set time limits on anesthesia during surgeries, relying on metrics from the Centers for Medicare and Medicaid Services (CMS) called “Physician Work Times” values.
According to Anthem, the change aimed to “safeguard against potential anesthesia provider overbilling” and improve healthcare affordability. Additionally, the policy would exclude maternity-related services and patients under 22. Providers would also have the option to challenge reimbursement decisions through a claims dispute process.
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“Anthem strives to help make health care simpler and more affordable,” it said. “One of the ways to achieve that goal is to help ensure that claims are accurately coded and providers are reimbursed appropriately for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”
However, critics were quick to argue that the policy disregarded the realities of medical care, where surgeries often extend unpredictably due to complications or patient-specific needs.
The American Society of Anesthesiologists (ASA) pointed out, “Anthem’s policy arbitrarily determines the time allotted for anesthesia care during a procedure, failing to account for surgeries that may require extra attention.” ASA President Donald Arnold continued, calling the move a “cynical money grab” that prioritized profits over patient safety.
Public Backlash: The Tipping Point
The public outrage came to a head following the fatal shooting of UnitedHealth CEO Brian Thompson, an event unrelated to Anthem’s policy but one that inflamed online vitriol against health insurers.
Social media users flooded platforms like X (formerly Twitter), sarcastically imagining patients being jolted awake mid-surgery due to Anthem’s proposed limits.
“Does Anthem expect patients to walk out of the operating room halfway through a procedure?” tweeted New York State Senator Mike Gianaris, who also promised to introduce legislation to prevent such practices.
The Role of Medical Professionals
Doctors and medical organizations across the board criticized the policy, highlighting its potential to jeopardize patient care. Dr. Dhivya Srinivasa, a breast cancer reconstructive surgeon, noted the inherent unpredictability of surgical procedures. “The issue here is that the time, the length of surgery, is a function of the surgeon, not the anesthesiologist,” she explained in an interview with NBC News.
In a statement following the policy reversal, the American Society of Anesthesiologists criticized the now-withdrawn policy as out of step with established standards, regulations, and billing practices, highlighting Anthem’s concerning disregard for patient safety.
“ASA welcomes Anthem’s decision but notes that Anthem’s recent policy proposal reflects a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms that recognize anesthesia services and care, especially for care provided in emergency situations, to patients of extreme age and for more complex and vulnerable patients who require additional care from an anesthesiologist.”
The ASA also raised concerns about the CMS metrics Anthem proposed to utilize, questioning their validity and applicability. CMS itself clarifies that Medicare reimburses anesthesia services without specific time limits, paying in 15-minute increments with adjustments for complexity.
Patients would end up paying the bill for the uncovered care making it less affordable when there is a complication. Surgeons would feel punitive to finish cases faster when they have no incentive to prolong a case.
Hence, Anthem’s policy would have forced patients to bear the burden of out-of-pocket expenses, potentially amounting to hundreds or even thousands of dollars.
Political Pressure and Anthem’s Retreat
The policy reversal wasn’t solely driven by public displeasure; political leaders in affected states played a pivotal role. New York Governor Katch Hochul condemned the proposal as “misguided” and claimed credit for Anthem’s U-turn.
“We pushed Anthem to reverse course, protecting New Yorkers from this harmful policy,” Hochul stated.
Connecticut Senator Chris Murphy echoed these sentiments, calling Anthem’s proposal “appalling” and accusing the company of prioritizing corporate profits over patient well-being.
Anthem, folding under the pressure, issued a statement that it would not proceed with the policy. The company maintained, however, that it was never its intention to withhold payment for medically necessary anesthesia services.
A Broader Issue: Profits vs. Patients
The Anthem saga highlights a larger problem within the U.S. healthcare system into spotlight: the tension between cost-cutting measures and patient care. While Anthem argued that the policy would curb overbilling and reduce costs, critics pointed to the insurer’s own profits.
In June, Elevance Health, the corporate parent of Anthem BCBS, reported a 24% year-over-year increase in net income, totaling $2.3 billion. This revelation only fueled suspicions that its policies were less about affordability and more about padding corporate earnings.
The proposed policy also highlighted the real-world implications of cost-cutting measures. In a letter to Christine Cappiello, Senior Director at Anthem, Connecticut State Senator and oncologist, Jeff Gordon described a hypothetical scenario in which a surgeon faces an unexpected complication.
Would they stop mid-procedure to avoid surpassing Anthem’s reimbursement limits?
“This policy is contrary to providing good and safe medical care for people in Connecticut and other states. It could lead to avoidable adverse events and/or unnecessary bad outcomes.” Gordon said. “Why would Anthem BCBS pursue such a policy?”
This sentiment was echoed by patient advocates, who warned that policies like Anthem’s could exacerbate medical debt- a problem that already affects millions of Americans.
Incidentally, Brian Thompson’s death drew national attention and sparked discussions about the healthcare industry. Thompson, the CEO of UnitedHealth – the health insurance arm of the $550 billion UnitedHealth Group – was fatally shot in a targeted attack in Midtown Manhattan. Adding to the intrigue, several outlets reported that bullet casings found at the scene were engraved with the words “deny,” “defend,” and “depose” – terms critics often associate with alleged strategies used by insurance companies to avoid paying claims.
Following a five-day manhunt, 26-year-old Luigi Mangione was arrested in Altoona, Pennsylvania, in connection with the murder.
Authorities discovered a manifesto in Mangione’s possession, expressing grievances against the healthcare industry and describing health insurance companies as “parasitic.”
The Power of Collective Action
Anthem’s decision to backtrack is a testament to the power of collective action. From professional associations and elected officials to everyday citizens, the overwhelming pushback forced one of the country’s largest insurers to reconsider.
Yet, this victory raises a critical question: How many other policies go unnoticed or unchallenged? Anthem’s initial announcement flew under the radar for weeks before backlash erupted.
This case underscores the need for transparency and accountability in healthcare policy. It also highlights the importance of vigilance from all stakeholders, i.e. patients, providers, and policymakers alike.
The Bigger Picture: A Healthcare System at a Crossroads
For too long, U.S. healthcare has been driven by the bottom line rather than patient outcomes. Anthem’s now-abandoned policy is just one example of how cost-cutting measures can clash with the realities of medical care.
The healthcare system faces a critical choice: continue down a path dominated by profit-driven decisions or pivot towards a more patient-centered approach. What’s required is a shift in focus. Insures must prioritize collaboration with medical professionals, ensuring policies reflect the complexity and unpredictability of real-world medicine.
Yes, Anthem’s reversal is a win – but it’s also a wake-up call. In a system as vast and complicated as U.S. healthcare, victories like this are rare. It underscores the need for sustained advocacy and vigilance to ensure that patient care remains at the forefront of healthcare decisions.
It also reveals the fragility of trust between insurers and their stakeholders.
For Anthem, the backlash – and the widespread criticism of its motivations – should serve as a lesson in the dangers of neglecting stakeholder input. Insurers must actively work to rebuild trust by demonstrating a genuine commitment to the well-being of their policyholders.
