Anthem Blue Cross Blue Shield Won’t Pay for the Complete Duration of Anesthesia for Patients’ Surgical Procedures

[ElChupacabra]

I'm so glad we don't have health insurance companies to deal with for our medical care.

Indeed, because it generally sucks to have to battle insurance companies to pay out for the services you expect them to cover. I've had to go through this with my mother recently and in the past, where some of her treatments became a real hassle to get paid. We would not except this level of service if it were any other kind of business.

 

[Rexedgar]

Its the title of a book talking about how the industry doesn't pay claims.

“Why Insurance Companies Don’t Pay And What You Can Do About It”

I don’t think this remedy was covered in the book. I wonder why the MSM hasn’t picked up on this…..

 

[Jack2aTee]

It’s a way to try to screw high risk patients and patients with preexisting conditions, etc…circumventing laws against that.

They’re basically telling those patients that they can’t get surgeries, etc if they can’t afford to pay out of pocket for anesthesia.

Because it’s those type of people that most often have surgeries that take longer.

I have no doubt they have determined the patient is high-risk for costs and so they're trying to figure out a way to off the patient "legally" to rid themselves of a future big expense. Don't put it past them.

 

[Callen]

Indeed, because it generally sucks to have to battle insurance companies to pay out for the services you expect them to cover. I've had to go through this with my mother recently and in the past, where some of her treatments became a real hassle to get paid. We would not except this level of service if it were any other kind of business

I was in hospital this summer for 5 days. Not one bill for anything including room, nurses, meds, multiple doctors even TV and WiFi. Mind you I would have gladly paid extra for decent food!!! The doctors and hospital bill the provincial healthcare directly. Patients are not involved.

 

[instagramsci]

same as it ever was

 

[Rexedgar]

I was in hospital this summer for 5 days. Not one bill for anything including room, nurses, meds, multiple doctors even TV and WiFi. Mind you I would have gladly paid extra for decent food!!! The doctors and hospital bill the provincial healthcare directly. Patients are not involved.

You guys need to up your lobbying!

 

[zincwarrior]

I was in hospital this summer for 5 days. Not one bill for anything including room, nurses, meds, multiple doctors even TV and WiFi. Mind you I would have gladly paid extra for decent food!!! The doctors and hospital bill the provincial healthcare directly. Patients are not involved.

Way to flex on us poorz Canuck!

 

[beefheart]

Good news.

 

[instagramsci]

Good news.

So many industries have to at least pretend to innovate to make more money. All insurance companies have to do is stuff like this. Wild that in a supposed first world country we leave it up to corporations

 

[beefheart]

So many industries have to at least pretend to innovate to make more money. All insurance companies have to do is stuff like this. Wild that in a supposed first world country we leave it up to corporations

Yeah, It is almost better for me to fly to Ireland and get healthcare with my citizenship....and free flights.

 

[Maidenrules29]

Really? Wow. Capitalism isn't the answer for everything. Single payer would be much better.

You don't think the administrators of a single-payer system would ever deny procedures? LOL. They would probably deny more.

 

[Hari Seldon]

You don't think the administrators of a single-payer system would ever deny procedures? LOL. They would probably deny more.

How does hundreds of millions going to insurance companies improve health care?

 

[Maidenrules29]

How does hundreds of millions going to insurance companies improve health care?

Its what we have. Remember how it got started?

 

[Parrish]

They've changed their minds. Good for their enrollees.

 

[Hari Seldon]

Its what we have. Remember how it got started?

You didn't answer the question.

 

[Greenbeard]

They've changed their minds. Good for their enrollees.

Maybe, maybe not. The presumption that health care providers are always in the right and insurers are always in the wrong (or that greed runs only one way) isn't really warranted.

What's really eye-opening (not that it's news that providers usually have the advantage in the PR war) is how thoroughly every media story on this absorbed the American Society of Anesthesiologists framing, other than a lone Vox article.

A big insurer backed off its plan to pay less for anesthesia. That’s bad.

Anesthesia services are billed partially on the basis of how long a procedure takes. This creates an incentive for anesthesiologists to err on the side of exaggerating how long their services were required during an operation. And there is evidence that some anesthesiologists may engage in overbilling by overstating the length of a procedure, or the degree of risk a patient faces in undergoing anesthesia.

Starting in February, Anthem had planned to discourage overbilling by adopting a set of maximum time limits for procedures, inspired by data from the Centers for Medicare and Medicaid Services. If an operation went long for medically necessary reasons, anesthesiologists could appeal for higher payment. But the process of reimbursement would be more arduous.

Critically, contrary to Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists, not patients, according to Christopher Garmon, associate professor of health administration at the University of Missouri-Kansas City’s Henry W. Bloch School of Management.

With its new policy, Anthem was attempting to do precisely this: force anesthesiologists to accept lower rates of reimbursement.

And the case for forcing down payment rates for anesthesiologists is especially strong. According to Medscape’s 2024 Anesthesiologist Salary Report, the average salary for an American anesthesiologist in 2023 was $472,000. This represented a $70,000 increase over the field’s average salary in 2022. This makes anesthesiologists among the top five highest-earning specialists in the United States.

If we want America’s health care system to treat more patients — while charging us all less money for coverage — then there is no alternative to forcing myriad specialists to accept lower payment rates. Ideally, we would do this through a comprehensive system of public cost controls and insurance provision. Failing that, we need private insurers to drive a harder bargain with the most expensive doctors and hospitals. When we demonize insurers for doing precisely that, we aren’t standing up against our health care sector’s profiteers — we’re sticking up for them.