Six months after a major insurance company withdrew plans for a policy that would have allowed health insurers to place time limits on anesthesia care, a New York State Assembly bill and a New York Senate bill may resurrect the policy.
Anthem Blue Cross Blue Shield floated a policy that would have placed time limits on procedures using anesthesia in Missouri, New York and Connecticut. Following feedback from patients, physicians and industry groups, Anthem withdrew the proposal.
Several states have since taken legislative action to ban such time limits altogether, including Washington, Missouri, Illinois and New Jersey.
A clause has been added to the two bills that would allow health insurers in New York to predetermine the time allowed for anesthesia care during surgery or a procedure.
Becker’s spoke with Donald Arnold, MD, president of the American Society of Anesthesiologists and chair of the department of anesthesiology at Mercy Hospital St. Louis about the new proposed legislation in New York and legislation in other states that would block these kinds of time limits.
Question: Is the ASA concerned about time limit legislation in any other states or from any other major insurers?
Dr. Donald Arnold: Health insurance companies have no shame. This is a perfect example of why the public does not trust big insurance. We received assurances from health insurers last year that this outrageous policy would not be pursued further. Yes, ASA is concerned about any proposal from health insurers and/or state legislators that interferes with appropriate care during surgery. At this time, New York is the only state ASA is aware of where insurers have pushed to bring this policy back. In fact, Maryland and Oklahoma have already approved new laws this year that prohibit these extreme policies. The Illinois legislature passed legislation last week that prohibits anesthesia time limits and will soon send the bill to the governor for signature.
Q: Can you expand on the harm these New York bills would pose for patients?
DA: Anesthesiologists provide individualized care to every patient, carefully assessing the patient’s health prior to surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed. They also attend to the patient during the entire procedure, resolve unexpected complications that may arise or extend the duration of the surgery, and then work to ensure the patient is comfortable during recovery. If this bill is passed, as amended, patient care could be affected by wrongfully denying anesthesia coverage for patients requiring longer surgeries – even for patient complications, surgical delays, and other issues outside the anesthesiologist’s control. The amended bill could also pressure surgical teams to hurry to meet the corporate insurance time limit. The operating room is not a place where patients want physicians to rush. Even though anesthesia time is well-defined by longstanding and existing federal regulation, there is also the unanswered question of how to treat anesthesia time beyond the insurer’s arbitrary time limit. If it is a non-covered service, then patients could be held responsible for the additional time and additional medical supplies used. That could allow insurers to potentially off-load healthcare costs to patients.
Q: Is the ASA optimistic about state-by-state legislation nationwide that would ban anesthesia time limits altogether?
DA: Based on the public outrage and comment that almost universally opposed the Elevance Health, Anthem BCBS’ appalling proposal last year, it would be hard to imagine that a scheme like this would pass into law. However, clearly health insurers have no problem putting profits over patients. These big insurance companies keep posting record profits and massive executive payrolls, all the while still scheming to abandon their beneficiaries when they are patients in the middle of surgery. Nine states introduced legislation this year that would prohibit anesthesia time limits.
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