I was astonished to read this news from the American Society of Anesthesiologists.
In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes. The American Society of Anesthesiologists calls on Anthem to reverse this proposal immediately.
. . .
Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards. With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem will deny payment for the anesthesiologist’s care. With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises.
There's more at the link.
Sure, one can argue that anesthetists are trying to protect their income stream, but there's a whole lot more to this than money. I'll use myself as an example. I've had multiple heart attacks, and have lived for over two decades with a partially disabling spinal injury involving 24/7/365 pain that can never be fully controlled, and consequently have limitations on movement and flexibility (and I'm carrying too much weight, because exercise is largely a memory). Dealing with those factors from an anesthetist's point of view includes allowing for my higher pain tolerance and medication resistance (because I take multiple medications every day, some of them fairly potent), and adjusting "normal" anesthetic protocols and dosages accordingly. I'm sure I fall outside the parameters that might govern a young, fit football player - but Anthem BCBS apparently doesn't care about that. If my time under anesthesia is longer than that needed by the football player, they won't pay for it, and they don't care that I'm a very different medical problem to the anesthetist than the athlete.
I think this absolutely sucks. All I can suggest is that you look closely at your own medical insurance, and ask pointed questions when it comes to the fine print. Medical insurers, of course, will cloak such limitations and restrictions in legalese and almost impenetrable linguistic obfuscation, so you'll have to read closely (and between the lines) to figure out what they mean - but if you don't, you might find your medical bills a lot higher than you'd planned for.
Sheesh!
Peter
EDITED TO ADD: Earlier today Anthem BCBS canceled its proposed policy change. One wonders how the murder, yesterday, of a top medical insurance professional factored into that . . .
24 comments:
The medical community is up against the ropes and are hemorrhaging credibility by the minute. Many anesthesiologists set up pain management clinics and expect to be treated like rock stars.
Glad I didn't have that policy for my rectal cancer surgery. What the surgeon estimated as 2 hours turned into over 10 hours trying to get a clean edge.
Hmmmmm......,wonder what might change their minds?
Wow they've gone to the Chilton manual model for surgical procedures. How elegant and annoying.
I have a metabolism that breaks down certain meds very fast. I have had multiple different procedures under local where it wore often so fast they had to give me multiple rounds to make it through.
Glad i don't live in those states
Exile1981
I wonder if the target assassination of UnitedHealth’s CEO will change their minds. So tired of companies and people not saying what they mean. This culture of “nice and kind” makes living cloudy.
Bean counters making medical decisions and overruling doctors - a trend that has been going on for some time now. Will they ever get charged with practicing medicine without a license?
@ Anonymous 10:39
fortunately or unfortunately this becomes the only way they begin to understand, even if this "recommendation" now carved into stone was likely written by someone who doesn't even have a GED
Trial balloon? Maybe if they get away with it, the next thing we see will be these parasites applying the same to *all* medical procedures: "Your open-heart surgery took longer than our guidelines? Piss off; no money for *you*!"
Maybe the recent assassination of the United Healthcare CEO was the result of a misidentification...
Connecticut state comptroller says anthem has reversed its decision in that state, per fox61 news. Hope so, anesthesiologists are not overpaid IMHO, worked as a scrub tech in Dallas during the 70s.
Rick m
I am a retired anesthesiologist, and there’s no way on earth I would go back!
Anesthesiologists contributed to this. Many surgeons get paid a flat rate for the surgery, but anesthesiologists bill by the minute. In some cases, for some insurers, if a surgery takes longer than expected, the surgeon gets a lower per-hour pay, and the anesthesiologist gets more money.
Also, anesthesiologists often run multiple patients in multiple operating rooms at the same time, so they can double or triple bill their time.
One has to wonder if this is the result of a small number of anesthesiologists who pad their hours when billing insurance. Rather than making the effort to prove fraud against the few, they create a rule that affects all, much like politicians do in regards to criminals and resulting gun laws.
Any kind of surgery when you include all the preop tests is gonna put you over the max out of pocket on most insurance plans so it seems like a nonissue.
My grandfather and uncles used a nurse anesthetist forever and they all used to laugh at the idea of anyone needing an MD to pass gas.
Medical billing and insurance are like military tech. Innovation followed by counter innovation. Doctors and healthcare organizations find creative and often dishonest ways to bill for services then insurers counter by setting arbitrary limits on reimbursement...often in violation of the insureds specified coverage. And the game continues with the actual patients the ones doing the suffering.
This does not bode well for the future of surgery.
This is how the CEOs of health insurance companies end up getting shot in the street by calm and purposeful men.
This
People are getting fed up:
https://www.yahoo.com/news/americans-little-sympathy-murdered-health-223930677.html
The American Medical Industry continues to push profits!
One thing you failed to mention Peter is how fast the surgeon works defines how long the patient needs anesthesia. When my neighbor who is a nurse anesthetist found who was going to work on my wife he was not happy. The orthopedic surgeon works at a snail's pace meaning the patient is out longer than desirable. This increases risks to the patient and a longer recovery time after surgery. The anesthetist has no control over the time factor.
Kinda OT: Doing X-ray in the OR, I glanced over to the anesthetist. Everything must've been going smoothly as he had the patient's chart on his clipboard flipped all the way to the end to do his crossword puzzle.
I have no reference point for anesthesiology issues specifically, but I used to practice as an insurance defense attorney, meaning the insurance companies hired my firm to represent the companies’ insureds. This proposed policy change, while walked back, doesn’t surprise me in the least. Insurance companies create their guidelines in order to pay as little as necessary. It was maddening while trying to bill for law practice. It would be worse to be capped when the time required is largely out of the practitioner’s control.
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