When Anthem Blue Cross Blue Shield said it will no longer pay for anesthesia care if the surgery or procedure exceeds an arbitrary time limit, parent company Elevance Health Inc ELV faced backlash and reneged on the policy change.
What Happened: In an update on Thursday, Elevance stated: “Based on feedback received and misinterpretation of our policy change, it is evident that our communication regarding this policy was not clear, and as a result, we have decided to not proceed with this policy change.”
The policy was slated to take effect in February 2025 in Connecticut, New York, and Missouri.
This policy followed a similar reversal by Blue Cross Blue Shield of Massachusetts earlier this year, which faced pushback for restricting anesthesia use during colonoscopies.
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Why It Matters: In a letter to Elevance Health’s executives, the American Society of Anesthesiologists (ASA) questioned the validity of using CMS data to determine anesthesia duration.
In December 2023, Blue Cross Blue Shield of Massachusetts said it would start enforcing Policy 154 on Monitored Anesthesia Care (MAC), meaning they will deny payment for many claims involving propofol or MAC, deeming it unnecessary for procedures like gastrointestinal (GI) endoscopies, colonoscopies, and other GI treatments.
Gastroenterologists scrutinized Elevance for cutting general anesthesia from coverage, citing how it would make procedures more difficult and discourage patients from getting checkups.
Price Action: Elevance stock is down 2.25% at $384.13 at last check Friday.
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