Anthem BCBS - Anesthesia coverage change

[ch33zw1z]

Anthem Insurance will no longer cap anesthesia coverage at certain time limits for CT, NY patients: official

Update: Anthem Blue Cross Blue Shield will no longer implement a policy to limit coverage of anesthesia, according to the state comptroller. See the original story below. Anyone with an Anthem Blue Cross Blue Shield plan will soon have to pay out of pocket for anesthesia if a surgery or...

www.nbcnewyork.com

Anthem Insurance in Missouri to cap anesthesia coverage after certain time limits

The health insurance giant announced the move would take effect Feb. 1, 2025.

www.kctv5.com

Seems a bit greedy if you ask me. But since Health care and insurance is not always cut n dry, figured I’d post it here to discuss

 

[Moonbeam]

I oppose for profit healthcare. In our society money takes president over human life. The two should not mix.

 

[KMFJD]

anything over the allotted time will be charged to the patient, if you have complications, well that's too fucking bad, pay up, stockholders demand your bloodmoney

 

[Brainonska511]

Bluesky

bsky.app

Not as bad as anesthesiologists and their trade group make it sound. BCBS is just adopting the standard used by CMS so that anesthesiologists can not longer pad their billing on the backs of privately insured patients.

 

[Brainonska511]

anything over the allotted time will be charged to the patient, if you have complications, well that's too fucking bad, pay up, stockholders demand your bloodmoney

Anesthesiologists are some of the highest paid doctors. Insurance companies aren't always so good, but let's not pretend that one of the highest paid specialties is only looking out for the patients in this particular billing change situation.

 

[ch33zw1z]

Anesthesiologists are some of the highest paid doctors. Insurance companies aren't always so good, but let's not pretend that one of the highest paid specialties is only looking out for the patients in this particular billing change situation.

Anecdotal - from my wife’s second birth, the anesthesiologist charged quite a bit, I can’t exactly recall but something like 50% of total bills

Im curious to see numbers regarding how many times they are billed over the expected amount….and what the procedures are that get billed over

I’m sure the health insurers have this information

 

[KMFJD]

People with business backgrounds making life and death medical decisions just doesn't sound like the best idea though

 

[Brainonska511]

Anecdotal - from my wife’s second birth, the anesthesiologist charged quite a bit, I can’t exactly recall but something like 50% of total bills

Im curious to see numbers regarding how many times they are billed over the expected amount….and what the procedures are that get billed over

I’m sure the health insurers have this information

Anesthesiologists are one of the prime sources for surprise billings, especially as out of network providers at in network facilities, if I recall correctly.

I don't think moving to a model that follows CMS is the death sentence people (in this case, anesthesiologists and their trade group) are trying to make it out to be. Perhaps the extremely highly compensated doctors and their union don't have the public's best interest at heart when they released their statements on this billing change. Plus, insurance companies are just an easy target to rile up anger against.

 

[ch33zw1z]

Anesthesiologists are one of the prime sources for surprise billings, especially as out of network providers at in network facilities, if I recall correctly.

I don't think moving to a model that follows CMS is the death sentence people (in this case, anesthesiologists and their trade group) are trying to make it out to be. Perhaps the extremely highly compensated doctors and their union don't have the public's best interest at heart when they released their statements on this billing change. Plus, insurance companies are just an easy target to rile up anger against.

Insurance companies are the most likely target because they are the gate keepers to our healthcare access. The doctors and the health insurers can both be bad, it’s not exclusive.

 

[hal2kilo]

Anesthesiologists are one of the prime sources for surprise billings, especially as out of network providers at in network facilities, if I recall correctly.

I don't think moving to a model that follows CMS is the death sentence people (in this case, anesthesiologists and their trade group) are trying to make it out to be. Perhaps the extremely highly compensated doctors and their union don't have the public's best interest at heart when they released their statements on this billing change. Plus, insurance companies are just an easy target to rile up anger against.

Don't know anything about risks and death rates for anesthesiologists, but they probably have a hell of a liability insurance premium payment. Not saying this is justification, just speculating.

 

[Brainonska511]

Don't know anything about risks and death rates for anesthesiologists, but they probably have a hell of a liability insurance premium payment. Not saying this is justification, just speculating.

Yes, they do have a kind of "you get one screw up and your done forever" sort of deal, and the whole training period from college through residency/fellowship to contend with. But collectively, the money being spent on healthcare is going somewhere, and one of those places is doctors' compensation.

Also, anesthesiologists have frequently been part of the surprise billing game by being out of network, so they aren't exactly the most sympathetic people here, and they certainly have a substantial conflict of interest in how this story is framed.

Overall, it's death by 1000 cuts in healthcare costs.

 

[KMFJD]

one of the main wastes of the US health care industry is administration, like i said earlier, having business executives determine what is necessary instead of medical professionals seems counter intuitive , perhaps it shouldn't be a for profit industry

 

[BoomerD]

Anesthesiologists are some of the highest paid doctors. Insurance companies aren't always so good, but let's not pretend that one of the highest paid specialties is only looking out for the patients in this particular billing change situation.

The anesthesiologist who did my pain management (lumbar epidurals) back in the mid-00s was making over $400K then...

 

[Moonbeam]

Insurance companies are the most likely target because they are the gate keepers to our healthcare access. The doctors and the health insurers can both be bad, it’s not exclusive.

Both are focused on money.

 

[SteveGrabowski]

Anecdotal - from my wife’s second birth, the anesthesiologist charged quite a bit, I can’t exactly recall but something like 50% of total bills

Im curious to see numbers regarding how many times they are billed over the expected amount….and what the procedures are that get billed over

I’m sure the health insurers have this information

My mom got stiffed completely (100%) on her anesthesiologist by her insurance in a breast cancer surgery like she was supposed to get it done wide awake or some shit. Can't remember if it was Community First Health Plans or Blue Cross Blue Shield of Texas. Probably the former but I have had to call and advocate for her over and over with both of those shitbag companies when they denied her coverage after she did everything they told her to ensure she'd be covered beforehand. It was such a breath of fresh air when she went on Medicare and didn't have to deal with these bullshit denials any more. Fuck private insurance and fuck Brian Thompson too.

 

[brycejones]

My mom got stiffed completely (100%) on her anesthesiologist by her insurance in a breast cancer surgery like she was supposed to get it done wide awake or some shit. Can't remember if it was Community First Health Plans or Blue Cross Blue Shield of Texas. Probably the former but I have had to call and advocate for her over and over with both of those shitbag companies when they denied her coverage after she did everything they told her to ensure she'd be covered beforehand. It was such a breath of fresh air when she went on Medicare and didn't have to deal with these bullshit denials any more. Fuck private insurance and fuck Brian Thompson too.

Private equity groups bought up a number of anesthesia practices and deliberately kept them out of networks but essentially locked down the market so they had to be used.

A whole new level of shit baggery.

 

[allisolm]

"After sharp criticism from anesthesiologists, an insurance company is halting its plan to limit the amount of time it would cover anesthesia used in surgeries and procedures. Anthem Blue Cross Blue Shield said on Thursday it would no longer move forward with the policy change."

They finally got something right.

https://www.cnn.com/2024/12/05/health/anthem-blue-cross-blue-shield-anesthesia-claim-limits/index.html

 

[Brainonska511]

"After sharp criticism from anesthesiologists, an insurance company is halting its plan to limit the amount of time it would cover anesthesia used in surgeries and procedures. Anthem Blue Cross Blue Shield said on Thursday it would no longer move forward with the policy change."

They finally got something right.

https://www.cnn.com/2024/12/05/health/anthem-blue-cross-blue-shield-anesthesia-claim-limits/index.html

Is Medicare/Medicaid wrong to use a time formula devised by CMS to decide how much to reimburse for anesthesiologists? Why would BCBS be in the wrong for following the payment model used by Medicare/Medicaid?

 

[HomerJS]

Imagine these greedy bastards charging out of pocket if you go into cardiac arrest during surgery.

 

[KMFJD]

Is Medicare/Medicaid wrong to use a time formula devised by CMS to decide how much to reimburse for anesthesiologists? Why would BCBS be in the wrong for following the payment model used by Medicare/Medicaid?

So, when you are on medicare/medicaid and surgery has complications and you require longer anaesthesia that does not meet the CMS guidelines, do they send you a huge bill to cover that like the insurance company does? what happens in those cases compared to when you are a BCBS plan that will likely cause great financial hardship?

 

[Brainonska511]

So, when you are on medicare/medicaid and surgery has complications and you require longer anaesthesia that does not meet the CMS guidelines, do they send you a huge bill to cover that like the insurance company does? what happens in those cases compared to when you are a BCBS plan that will likely cause great financial hardship?

Why do you assume if a part of a claim is disallowed that it will be back-billed? I've seen plenty of disallowed charges for services I received in-network and never back-billed for the marked down or disallowed components.

I'm certainly not an expert, but Medicare is fairly strict with billing and what is/isn't allowed. Why is it bad if a private company adopts a similar cost control measure to save us all money? It's not like anesthesiologists are hurting for money here.

What would probably have to happen if a surgery ran longer and they needed additional payment would be more paperwork to support the claim, otherwise, they'll just get the contracted amount for a particular surgery.

 

[allisolm]

Is Medicare/Medicaid wrong to use a time formula devised by CMS to decide how much to reimburse for anesthesiologists? Why would BCBS be in the wrong for following the payment model used by Medicare/Medicaid?

Yes, they are wrong if the end result is that patients get billed for anesthesia that is required for a longer time than their formula decrees is allowed. You don't pay extra for a longer than anticipated use of the operating suite and you don't pay more for the surgeon or the nurses even if they have to work longer to get the surgery done.

 

[Brainonska511]

Yes, they are wrong if the end result is that patients get billed for anesthesia that is required for a longer time than their formula decrees is allowed. You don't pay extra for a longer than anticipated use of the operating suite and you don't pay more for the surgeon or the nurses even if they have to work longer to get the surgery done.

I don't see anything inherently wrong with the Medicare formula: sometimes you finish early and win, and sometimes you finish late and lose. And if there are additional billing codes needed to account for unexpected stuff, then there might be an avenue for additional reimbursement.

But we're never going to get affordable single payer if we can't control reimbursement rates for some of the highest paid people in medicine.

 

[Brainonska511]

Yes, they are wrong if the end result is that patients get billed for anesthesia that is required for a longer time than their formula decrees is allowed. You don't pay extra for a longer than anticipated use of the operating suite and you don't pay more for the surgeon or the nurses even if they have to work longer to get the surgery done.

Also, the no surprises billing act (2022) prevents balance billing. You go to an in network place, you pay your cost sharing and can't be back billed for things not covered, at least that's how it was supposed to be work. Anesthesiologists already hated that bill because they were a big time supplier of surprise bills by being out of network.

 

[allisolm]

I don't see anything inherently wrong with the Medicare formula: sometimes you finish early and win, and sometimes you finish late and lose. And if there are additional billing codes needed to account for unexpected stuff, then there might be an avenue for additional reimbursement.

But we're never going to get affordable single payer if we can't control reimbursement rates for some of the highest paid people in medicine.

Again - IF the end result were to be, as the OP article says, charging patients for the overtime anesthesia, that is not any more acceptable than what currently exists.