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Big insurance companies have used increasingly aggressive, profit-driven behaviors to harm frontline physicians and health care professionals. Insurance companies have developed, proposed, and implemented several workarounds to federal and state regulations, renegotiated anesthesia contracts mid-way through agreed upon terms, and have failed to appropriately pay for anesthesia services.
Anesthesiologists and their practices are often at a disadvantage when assessing the impact policy changes will have on their revenues and their ability to cover service lines. Many insurance companies have leveraged their stranglehold on state-level insurance markets to slash payments to front-line health care professionals, often without regard to patient or clinical needs. ASA and its members want to protect patient access to care, ensure accountability among insurers, and promote transparency in health care cost savings.
Faced with some bad insurance behaviors? ASA’s policy positions and calls to action are listed below.
Anesthesia Payments Consider Individual Patient Conditions and Needs
Payments for anesthesia services are rather straightforward – (Base Units + Anesthesia Time) multiplied by a conversion factor. For more complex patients who require additional care, preparation, and coordination of patient care, anesthesiologists earn appropriate compensation with Physical Status Modifiers. If the patient requires emergency care, is of an extreme age, or finds themselves in other situations, anesthesiologists are provided modest compensation for those qualifying circumstances. Anesthesiologists are there for their patients during their most vulnerable times – fair compensation using long-established payment norms for the work of anesthesiologists is common sense.
Recent Insurance Proposals Undermine Common Billing Standards
In late 2024, Anthem plans in Colorado, Connecticut, Missouri, and New York, proposed to upend common billing and coding practices by proposing to pay for a portion of a patient’s anesthetic need. The policy, now rescinded, would have denied anesthesiologist payments for patients who may require longer surgeries or have complications that result in anesthesia time longer than Anthem's arbitrary time limits. The proposal sought to use an arbitrary and untested model for assigning anesthesia time instead of relying on the anesthetic record. Anesthesia time is defined in federal regulations and is an accepted standard throughout health care. Anthem’s proposed policy was inconsistent with prevailing industry standards, regulations, and billing norms.
Insurers Fail Patients By Not Recognizing Individual Anesthesia Needs
Insurance companies have also pursued policies to cut payments to anesthesiologists who provide services to complex patients. By arbitrarily removing payments for complex patients, insurance companies are bucking a trend in health care – that patient care be individualized and cost savings occur because of the actions of anesthesiologists to ensure advanced patient preparation and care coordination. Short-sided policies to no longer pay for physical status modifiers and qualifying circumstances means that anesthesia groups, hospitals, and patients will need to cover for the bad policy decisions of insurance companies.
Insurers Slow Walk Payments, Hide Behind the No Surprises Act
Insurers are using the No Surprises Act to hide from and delay paying for anesthesia services. When taken to arbitration for these payment disputes, federal arbitrators in 2024 sided with anesthesiologists and their groups more than 80% of the time, awarding anesthesiologists fair payment from insurers. But oftentimes, insurance companies see little urgency on paying on such claims. Do you know the No Surprises Act like you should?
ASA Committee on Economics physicians and ASA Advocacy and Quality staff are key leaders in pushing back against payment policies that jeopardize physician payments and place unnecessary administrative and cost burdens on physicians, hospitals, and patients. We work with state component societies to track and monitor policy changes. We engage federal regulators on ensuring the continued use of transparent payment policies that support continued patient access to anesthesia care and pain medicine. We advocate for private payers to provide fair and appropriate payments for anesthesia care and pain medicine services received by their customers.
Anesthesiologists are encouraged to better understand how their services are paid and the importance of appropriate documentation. Anesthesiologist group and practice leaders should routinely assess their contracts with and payments from insurance companies. When unfair changes to payer policies are proposed, anesthesiologists and their groups need to quickly assess the impact such policies would have on revenue, service line coverage, and patient access to timely care.
To sign up for alerts and be engaged on payment issues, please contact ASA Advocacy at [email protected].
This page was last updated December 4, 2024.