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| - On Nov. 1, 2024, Anthem Blue Cross Blue Shield did announce it would restrict coverage of anesthesia costs in accordance with surgical procedure time limits set by the federal agency that administers Medicare and Medicaid. However, in response to a backlash to the announced policy change, Anthem walked back the announcement on Dec. 5, 2024, and said it would not proceed with the change.
In December 2024, rumors spread that the private commercial health insurance company Anthem Blue Cross Blue Shield would only cover the cost of anesthesia up to certain time limits during procedures that require it.
For example, U.S. Rep. Ro Khanna, a Democrat from California, posted about it on Dec. 5, 2024:
As of this writing, the post had garnered 59,000 views and 1,600 likes. The claim appeared on X, as well as on Reddit and TikTok. On X, users sought to correct the poster's understanding of the announcement, saying that the private insurer was merely attempting to align itself with existing Medicare practices, and linking to a document that supposedly explained as much.
As we'll see, the private health insurer did announce such a policy, but later recanted the announcement and reversed the policy after facing backlash from anesthesiologists. We therefore rate this claim as outdated.
In an announcement published on Nov. 1, 2024, (archived) the health insurance company said it would limit its reimbursement of anesthesia costs (emphasis ours):
We will utilize the CMS [Centers for Medicare and Medicaid services, a federal agency] Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will be denied.
The announcement added that this new policy would not apply to people 22 and younger, or to maternity care. The policy concerned the insurer's coverage in Connecticut, Missouri and New York.
A search for CMS physician work time values revealed a downloadable spreadsheet on the website for 2025. We also found a document explaining how CMS collected data on these, and the implication of its findings on the Physician Fee Schedule. We contacted CMS seeking a deeper explanation of how the agency used this information for Medicaid and Medicare, and how these values would apply to a private commercial insurance company, if at all. We also asked whether this was indeed, as some X users thought, current practice for Medicare. We will update this report should they reply.
However a spokesperson for CMS told NBC News in a statement that "CMS pays for anesthesia services in 15-minute increments with an additional fixed payment to account for the complexity of the procedure." In other words, CMS says it does not apply specific time limits when covering the cost of anesthesia, contrary to the rule announced by Anthem Blue Cross Blue Shield. The spokesperson did not venture a rationale for the policy outlined by the private insurer.
Further, we know that anesthesiologists criticized these time limits as "arbitrary." On Nov. 14, 2024, the American Society for Anesthesiologists sharply rebuked the announcement (emphasis ours):
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.
[…]
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.
In the statement, the ASA added a link to a Nov. 12, 2024, letter its president, Donald Arnold, sent to the chief executive officer and the chief health officer of Elevance Health, the parent company of Anthem. "Anthem should rescind this inappropriate and misguided policy change immediately. We request a meeting by November 15 with Anthem officials who have the authority to revoke this policy change," Arnold wrote.
Anthem Blue Cross Blue Shield is a group of independent health insurance companies that share a network of providers, though they sell their plans independently from each other. Anthem, which is not present in every U.S. state, is the brand name of the insurance plans offered by Elevance Health, which is publicly traded.
Faced with the backlash, Anthem Blue Cross Blue Shield retracted its announcement of the policy change on Dec. 5, 2024, and said it would not proceed with it.
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