Anthem BCBS Has Sudden, Mysterious Change Of Heart On Anesthesia — But Did We Get Played?
Spoiler: We did not, but one problem with our healthcare system is that it is very, very confusing and very, very opaque.
Earlier this week, Anthem Blue Cross Blue Shield announced that it would no longer cover anesthesia in surgeries beyond a certain time limit — a prospect that scared the pants off of many of us, as we pictured doctors rushing through operations, waking up in the middle of open heart surgery, or surprise bills charging us thousands for anesthesia that our insurance company refused to cover. After all, we are a country full of people very accustomed to getting screwed over every which way by both insurance companies and providers.
Yesterday afternoon — seemingly apropos of the nation issuing a loud “Hey, I get it” in response to the murder of UnitedHealthcare’s CEO — Anthem reversed course and announced that it would not be doing that, after all.
Some of us breathed a sigh of relief. I know I did!
But now … some people are saying that we actually got played by a powerful lobby that doesn’t care about us so much as they care about getting anesthesiologists paid lots and lots of money. This would not be all that surprising, as anesthesiologists are among the highest paid doctors — making an average of $438,200 a year in the United States.
The other side is that Anthem was actually just doing this because, they believe, anesthesiologists “pad their time,” and that they were really just planning to hold them to the same standards that Medicare and Medicaid do.
“So what happened here is that the lobbying group for anesthesiologists made a press release attacking an insurer for trying to hold their practice to Medicare payment standards, lefty online agitators shared it in order to go viral and get retweets, and now we’re trying to get the CEO assassinated?” wrote Will Stancil, a researcher and professional “progressive” explainer of why progressives are always wrong about everything, on Bluesky, referring to a joke tweet from Taylor Lorenz featuring a picture of the CEO of Anthem.
Others noted that anesthesiologists had recently been targeted over “surprise billing” by Lina Khan and the FTC.
“So many people got duped. The media, healthcare activists, insurance regulators, everyone. Blue Cross was just trying to adopt the same anti-fraud rules Medicare *already* uses when paying anesthesiologists. And a doctor trade group bullied them into backing down. And people are celebrating this!” said RawStory reporter Matthew Chapman, who also claimed that such rules would bring the cost of premiums down.
This was also Anthem’s take, mostly.
Via NPR:
“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change,” the company said in a statement to NPR on Thursday afternoon.
“To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” the company added. “The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
Anthem had said that starting in February it would use metrics — known as Physician Work Time values — from the Centers for Medicare and Medicaid Services (CMS) to “target the number of minutes reported for anesthesia services.”
“Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount,” it said in a note to New York providers earlier this week.
Now — let’s be clear here. Absolutely nothing will bring the cost of premiums down once these companies know people will pay for higher premiums. They will never, ever pass on the savings to you, the consumer. They will take the money they save and they will pass it on to their shareholders, as they are obligated to do.
And as to the claim itself, that Anthem is simply following Medicare’s lead, Medicare says actually, no.
On Friday, a CMS spokesperson said Medicare covers anesthesia without specific time limits and doesn’t limit payment for anesthesia services.
"CMS pays for anesthesia services in 15-minute increments with an additional fixed payment to account for the complexity of the procedure," the spokesperson said in a statement.
Personally, I don’t think anyone got “suckered” — because, at the end of the day, it’s still the consumer who would be paying more for any additional anesthesia they might need. There’s not really any actual proof that any surgeons are going around making operations longer in order to ensure that health insurance companies pay their anesthesiologists more money, and until there is, I think that’s a pretty extreme claim to make.
What has been a problem, however, is some crazy anti-antitrust practices anesthesiology groups have been perpetrating, which leads to people being charged for “out of network” anesthesiologists on operations that were supposed to be covered by one’s insurance. That is why anesthesiologists have recently been targeted by Lina Khan and the FTC. (And those “surprise bills,” when an anesthesiologist is “out of network” at an in-network facility, were outlawed by the No Surprises Act in 2022, for as long as that one lasts!)
Still, if this were a Reddit “Am I The Asshole?” query, the verdict would probably lie somewhere in between “Anthem Is The Asshole” and “Everyone Sucks Here.” I also don’t think that anyone was appalled by this because they were thinking of the poor anesthesiologists who only make $500,000 a year, but rather of themselves, given that they would the the ones expected to cover the difference.
The real problem is that we’re getting played all over the place by the for-profit healthcare industry and there really isn’t a good answer beyond “abolish private health insurance” and replace it with single payer Medicare for All.
I understand and empathize with the fact that a lot of people want to be able to have it both ways. They hear about that survey where a majority of people immediately turned on the idea of Medicare for All when told it would involve abolishing private insurance, and they get scared. Reasonably!
Via Vox:
Bernie Sanders’s Medicare-for-all plan, as currently written, would cancel every private insurance plan in the country. Polling suggests that’s lethal: When told that Medicare-for-all would abolish private insurance, respondents flip from favoring the plan by a 56 percent to 38 percent margin to opposing it by a 58 percent to 37 percent margin. These numbers, when combined with the Obamacare backlash and the Clintoncare experience, have underscored reformers’ view that a plan that takes away the private insurance people have and like is doomed.
But what I have wondered for years is what would have happened if they had simply pointed out to those people that Sanders’s Medicare for All plan was that all medical care would be covered and free-at-the-point-of-service, while private insurers get to pick and choose what is covered? Would they have flipped back? Or would they still say “No, we’d still rather have the option of paying lots of money to private insurance companies who get to pick and choose and often surprise us with what they will and will not cover!”
We will probably never know. But I do have a feeling that the popular reading of this, that “people just really love private health insurance companies and don’t want to see them go!” … might not be entirely accurate.
If this week has taught us anything, it is that people do not, in fact, love their private health care companies — and that we are sick to death of being taken advantage of by those looking to rake in huge profits from our sicknesses.
It’s unlikely that things will change any time soon, given the current political makeup of things, but that doesn’t mean things have to be this way forever.
PREVIOUSLY ON WONKETTE!
The United Healthcare CEO shooter seems to have disappeared. It is unknown whether he remains in NYC or if he left shortly after the shooting. He doesn't seem to have a criminal record and no one has come forward and offer the NYPD a tip regarding his identity or whereabouts. Considering social media's response to the shooting, which was "hooray", if I were a CEO of a health insurance company right now I wouldn't try to screw with the customers right now. It could wind up killing you.
As long as Blue Cross takes it in the neck, I don’t really care what happened here.
The one time I took my very Long Island college girlfriend cliff-jumping she swallowed a bunch of water and ended up with the worst case of Giardia I’ve ever seen. She was covered by her father’s BCBS plan but I had to watch her suffer for a week while the insurance company dawdled over whether or not they were going to cover her treatment.
She was a piece of shit, but nobody deserves that, and my Ukrainian ass holds grudges.