Anesthesia Time Limited????

[barkley]

I honestly thought the morning drive dj's were joking when I heard them discussing this but a bit of research finds it to be true and just mind blowing to me-

In the States of New York, Connecticut and Missouri Anthem Blue Cross/Blue Shield has announced a proposed new policy effective Februrary of 2025 that will no longer reimburse anesthesia services for the complete duration of certain surgical procedures, opting instead for a partial coverage model, With this new policy, Anthem will arbitrarily predetermine the time allowed for anesthesia care during a surgery or procedure.

So from what i've read, in the case of a surgery that takes longer than Anthem's data model believes is appropriate (could be due to complications, more extensive work needed, individual patient's needs...whatever) Anthem will not cover the additional anesthesia costs and provider services.

This concept petrifies me-I do not want some data model putting a time clock on how long my trained and experienced medical provider has to deal with what could be life saving surgical intervention. I envision it like one of those old movies where the bomb detonator is ticking down the minutes and if it gets to zero you're out of time

 

[Marrila]

I think this increases the risk to patients that surgical medical practices will quit accepting the insurance.

 

[soccerdad72]

Not that this makes it any better, but I would assume that they would continue to administer anesthesia as long as necessary, just that the cost wouldn't be covered by insurance and you'd be billed accordingly.

 

[shh]

This is the most insane thing I've heard about anything healthcare and insurance related - and that's a pretty high bar already.

 

[China Expat]

Unreal. I have traveled the world extensively, and I can say our health insurance is frightening for those without ample means. I sustained a head injury in Thailand in JUne while doing my annual volunteer work with elephants, and walked into a beautiful five star hospital in Chiang Mai at 9:25 am, no appointment, and walked out 55 minutes later with a completed CT scan and long consult with a neurologist. $200.

 

[BrianL]

Not that this makes it any better, but I would assume that they would continue to administer anesthesia as long as necessary, just that the cost wouldn't be covered by insurance and you'd be billed accordingly.

This is correct, but will the policy cause medical practitioners to try and "hurry up" or otehrwise be careless. What happens if you can't pay? Anesthesia is expensive! Would they refuse the procedure entirely if they don't think it can be done within the time constraint? Will they just not accept this company's insurance? This is quite problematic.

You'd think the executives at Blue Cross/Blue Shield might have been reading the news.

 

[soccerdad72]

This is correct, but will the policy cause medical practitioners to try and "hurry up" or otehrwise be careless. What happens if you can't pay? Anesthesia is expensive! Would they refuse the procedure entirely if they don't think it can be done within the time constraint? Will they just not accept this company's insurance? This is quite problematic.

I agree there's all sorts of potential problems, issues and questions about this policy. Nothing has been mentioned as to who is even determining what is going to be considered the predetermined time for each surgery. I'm no surgeon, but I have to imagine that there's a whole host of things that can happen in surgery to cause a lengthier time under anesthesia.

 

[RedAngie]

DH had inguinal hernia surgery in August. It was more complicated that anticipated and the surgery team found another issue that needed attention too. He was in the operating room about 2 hours longer than originally estimated and was admitted for overnight observation. Everything turned out fine.

I heard that the surgery/anesthesia for the next patient was delayed and the family was getting antsy.

The “bill” for everything was something like 25K. I wonder what 2 extra hours of anesthesia would cost out of pocket.

 

[Rogue1677x]

In my family we have a genetic condition where the ones tested positive have an allergic reaction to general anesthesia but even those of us who are negative are treated with the same precautions. Because of this, every surgery and procedure I've had includes extra prep time and they've got a cart with supplies ready in case it's needed.

 

[Mackenzie Click-Mickelson]

Not that this makes it any better, but I would assume that they would continue to administer anesthesia as long as necessary, just that the cost wouldn't be covered by insurance and you'd be billed accordingly.

IDK the wording from a local news story says "Claims submitted with reported time above the established number of minutes will be denied.” That doesn't sound like a pro-rated charge wherein time under the limit is covered and time over the limit is billed without coverage. But I would hope there's further clarification on that.

 

[georgina]

This is correct, but will the policy cause medical practitioners to try and "hurry up" or otehrwise be careless. What happens if you can't pay? Anesthesia is expensive! Would they refuse the procedure entirely if they don't think it can be done within the time constraint? Will they just not accept this company's insurance? This is quite problematic.

You'd think the executives at Blue Cross/Blue Shield might have been reading the news.

When I have had surgery, the anesthesia providers were a completely separate medical practice from the surgeon and the hospital. Not sure the surgeon would do anything differently with the anesthesia time constraints.

 

[emmybee]

This country is nuts for accepting profit motives over the lives, health, and safety of our loved ones. I imagine the bad press will make them back down on this, but it isn't hard to think of the countless other ways insurance companies exert their negative influence in our relationship between us and our doctors. We wholly believe the fearmongering while ignoring the fact the Americans pay much more and get way less for our money. We deny ourselves or prolong seeking the care we need. We drown in medical debt. We look to our community for handouts to because insurance won't pay. I am currently fine when it comes to my insurance, but I know I'll get kicked off as soon as I'm unable to work due to long term illness or injury. It sickens me that my fellow citizens have to put up with this garbage.

 

[sam_gordon]

According to a poster on the CT thread discussing this, this is already in place for Medicare/Medicaid patients. The big question is "who pays" if a surgery takes longer than "allowed"? Is there an "appeal" process? Some kind of explanation? Patients don't get much say (if any) in who the anesthesiologist is, much less how long a procedure takes.

 

[LoveDaisy]

Caught my local news at lunch (WFSB a cbs affiliate) and they had breaking news this will not be coming to CT.

The app won’t let me post the link so here is a screenshot