On Consumerism
By Arthur Vidro
Perhaps the strangest consumerism story of 2024 was the attempt by health insurance provider Anthem to link its coverage of anesthesia in a surgery with the amount of time the patient is rendered unconscious.
I can imagine how Anthem’s desired change might have played out.
There I am, being wheeled into surgery to have my appendix removed, or a hernia fixed, or maybe to swap an old pacemaker with a new one.
As the gurney glides me to the operating room, I speak to the surgical team walking alongside:
“OK, folks, let’s synchronize our wristwatches.” Once they had done so, I would add, “And remember, if we’re not through by noon, wake me up so I can decide whether to have you continue. Because I don’t want to incur overtime anesthesiology charges that I can’t afford to pay.”
That’s the weird world Anthem was setting us up for.
Anthem, also known as Blue Cross/Blue Shield, announced at the start of November that it would be making changes to its coverage of anesthesia bills starting in February 2025.
Anthem had what, to them, was a bright idea: establish a target number of minutes for anesthesia use, based upon type of surgery, and then limit its insurance coverage to that amount of time.
Anthem insists it wasn’t being arbitrary. Anthem would later defend its proposed plan by saying they were using “Medicare metrics” to let their computers calculate the number of allowed minutes for anesthesia.
If that time limit gets exceeded, well, what would happen?
Medical folks around the country chimed in, saying their take of the proposal was that if a patient has surgery that lasts longer than the standard accepted by Anthem, then Anthem has absolved itself of any responsibility to pay for the anesthesia needed for the rest of the encounter. Any anesthetic care after the time limit would be denied. This, of course, would leave the patient on the hook for the remainder of the anesthesiology bill.
Anesthesiologists were especially outraged. They pointed out, correctly, that the pace of the surgeon dictates the surgery. They themselves have nothing to do with a surgery’s duration. They did not want to be penalized if they were assigned to a more meticulous surgeon. (As an occasional patient, I prefer meticulous surgeons over the speedsters. But I’m not Anthem.)
Anthem insisted it wasn’t trying to cut off payments to anesthesiologists, that it would pay “established Medicare rates” for any period of overtime an operation entails.
Whether Anthem is correct in its statement of what would have happened in surgery overtime, I don’t know.
But Anthem’s attempt to use so-called Medicare metrics ignores the human element in medicine. No professional should have to work while a timekeeper is clocking their every move. But such is the automated world we are creating. Anything that can be measured must be measured. All in the name of efficiency.
Never mind that unexpected complications may arise to extend the duration of a surgery. Or that given two identical scheduled surgeries, something in particular about one patient, such as a pre-existing condition, might dictate a somewhat different approach for the surgeon.
The proposal by Anthem would have gone into effect at the start of February, at first in just Connecticut, Missouri and New York. But it would have affected other states later on. To the company’s credit, even its original proposal provided exceptions for maternity care and patients who are minors.
Sen. Chris Murphy of Connecticut wrote that Anthem’s plan would be “saddling patients with thousands of dollars in surprise additional medical debt.”
So, what happened to put the nix to the plan?
Anthem’s statements, while still defending its original plan, claimed “widespread misinformation” had been generated about it, prompting their decision to abandon the plan.
Sounds to me like typical legalese gobbledygook to avoid admitting their idea was ridiculous.
In defending its plan, Anthem reminded everyone of its appeal system that patients can use to get coverage for a denied claim.
I have used their appeal system. The umpire who decides on the appeal is — you guessed it — a medical pro being paid by Anthem.
And remember, the insignificant patient has no say in choosing an anesthesiologist. Even if they did choose one. Or, as I once did, verify ahead of time that an assigned anesthesiologist is covered by one’s health plan; there is nothing to prevent a last-minute switch in anesthesiologists, from one covered by your health plan to one omitted from your health plan.
In early January, Anthem pulled the plug on its proposed change.
One day earlier, a vile gunman had murdered the chief executive officer of health insurance provider United Health Care. The murdering gunman was outraged by the often unjustifiable decisions made by health insurance companies in denying claims made for the care of policyholders.
But according to Anthem, that incident had nothing to do with its decision to reverse course.
Whatever the reason for its cancellation, this plan was horribly misbegotten.
