Now, these insurance executives may not look at themselves in such a negative light. To them, they’re just trying to increase their margins and maintain profitability; but, often, their tactics are undermining the caregivers of the very patients they insure. That is certainly the feeling among many within the anesthesia specialty.
Anesthesia Under Assault
Late last year, the American Society of Anesthesiologists (ASA) published an article outlining recent policy shifts among certain payers that have had the effect of reducing reimbursement to anesthesia providers. Not all payers are involved, but there is a sufficient number of health insurers engaged in these tactics that the ASA felt compelled to draw their members’ attention to what appears to be a growing trend and a serious concern.
According to the ASA, big insurance companies have used “increasingly aggressive, profit-driven behaviors to harm frontline physicians and healthcare professionals.” In the ASA’s assessment, these payers have implemented several workarounds to federal and state regulations, renegotiated anesthesia contracts mid-way through agreed upon terms, and failed to appropriately pay for anesthesia services. “Many insurance companies have leveraged their stranglehold on state-level insurance markets to slash payments to front-line healthcare professionals, often without regard to patient or clinical needs.”
Measuring the Mayhem
The ASA then went on to provide recent examples of payers behaving badly, especially in the anesthesia reimbursement context. Below are a few of those examples.
- Anthem Blue Cross Blue Shield (BCBS) has a new payment policy that took effect January 1, 2026 in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin. Under this policy, Anthem will reduce facility payments by 10% if any services are rendered by out-of-network providers. To avoid this penalty, many hospitals will feel pressured to cut ties with anesthesia groups who are not contracted with Anthem.
- In late 2024, Anthem plans in Colorado, Connecticut, Missouri and New York proposed a policy that would have limited payments in cases where the anesthesia time goes beyond Anthem's arbitrary time standards. The proposal sought to use an untested model for assigning anesthesia time instead of relying on the anesthetic record. Thankfully, this policy proposal was withdrawn, but it remains another example of the current mindset of certain payers when it comes to limiting anesthesia reimbursement.
- Also in 2024, Aetna and BCBS in several states announced that they would no longer make additional payment based on a patient’s physical status.
- Anthem also announced that, effective November 2024, they would no longer pay for qualifying circumstance codes—including 99100, 99116, 99135 and 99140. These codes reflect extreme or difficult clinical circumstances that is not captured in the valuation of the anesthesia code set.
- According to the ASA, “insurers are using the No Surprises Act to hide from and delay paying for anesthesia services.” Fortunately, when taken to arbitration, federal mediators in 2024 sided with anesthesiologists more than 80% of the time, awarding anesthesiologists fair payment from insurers. “But oftentimes, insurance companies see little urgency in paying such claims.”
And, then, there are other recent examples of certain payers targeting anesthesia claims. Back in January, we sent out special alerts informing our readers that both Highmark and Premera were lowering reimbursement in QZ cases (non-medically directed CRNA) from 100% to 85% of the allowable. While these reductions only apply in a limited number of states, these are precedent-setting policy changes that diverge from long-standing reimbursement norms.
It’s vital that anesthesia providers stand with their medical societies and insist that their voices be heard. Together, we can help to rein in those payers that are on the edge of bad behavior.