Anthem Blue Cross Blue Shield has reversed its decision on a controversial anesthesia reimbursement policy update — leaving many leaders wondering if this could signal a broader shift.
Amid outrage from anesthesia leaders, the payer said the reversal was spurred from "widespread misinformation" surrounding the update, which would have introduced a new reimbursement structure based on CMS physician work time values.
Twenty-one anesthesiologists and certified registered nurse anesthetists connected with Becker's to discuss what the move could say about the future of insurance behavior.
Question 2: Do you think Anthem BCBS’s reversal could signal a broader shift in how payers approach anesthesia reimbursement policies, or do you see this as an isolated incident?
Editor's note: Responses were edited lightly for clarity and length.
George Anastasian, MD. Chief of Anesthesiology at White Plains (N.Y.) Hospital: This proposed move plainly exposes insurance companies' drive to increase profits. I expect more tricks down the line to deny or curtail anesthesia claims.
Alan Bielsky, MD. Anesthesiologist at Children's Hospital Colorado (Aurora): I think this does not signal any shift. They just got caught and shamed publicly.
Brian Cross, CRNA. Owner of CS Anesthesia (Youngstown, Ohio): What I expect is for Anthem and other insurance companies to continue to look for ways to reduce payment to medical providers in order to maintain their individual million-floor bonuses every year.
Katy Dean, CRNA. Certified registered nurse anesthetist in Yorktown, Va.: CMS has decreased anesthesia reimbursement a total of 8.2% from 2019-2024, with another 2.2% slated for 2025. This discrepancy between government and private pay has insurance companies looking for ways to decrease reimbursement. Cuts that can affect patient care so drastically need to be stopped. We are in the business of taking care of people, not taking advantage of them.
Bob Ebener, DO. Anesthesiologist in Middleburg, Fla.: I believe that payers are always looking for ways to cut reimbursement to cut costs. This is just an example of an overreach that even the public had realized. They will certainly come up with other ways to keep the patient's money and pay as few of their bills as possible.
Ladan Eshkevari, PhD, CRNA. Editor-in-Chief of the AANA Journal and Professor at Georgetown University (Washington, D.C.): I am hopeful that a misguided decision such as this will have a postmortem analysis by Anthem to figure out what went wrong, i.e. how the decision was made and who were the personnel responsible for making it. Obviously, I do not know what the future will hold, but I think if the insurance companies can't regulate themselves internally against these grave decisions, perhaps Congress needs to start putting some guardrails and regulation in place on how decisions are made by insurance companies. Of course, that would take an act of Congress, pun intended!
Megan Friedman, DO. Anesthesiologist and Director of Pacific Coast Anesthesia Consultants (Los Angeles): While Anthem's reversal is a positive step, it is likely a response to strong advocacy rather than a broader trend. Insurers often prioritize cost containment, and this incident highlights the need for continued vigilance from medical professionals and organizations. Policies that undermine care quality or place undue financial burdens on providers can create ripple effects, worsening staffing shortages and increasing costs for patients and facilities.
That said, this case serves as a reminder that collaborative dialogue between payers and providers is essential. It is possible that other insurers will take note of the backlash and tread more carefully when proposing similar changes. However, sustained advocacy and evidence-based discussions will be needed to ensure reimbursement policies align with the realities of patient care.
Dewey Galeas, CRNA. Certified registered nurse anesthetist in Grovetown, Ga.: Unfortunately, I see Anthem's policy as a current and continuing trend in anesthesia reimbursement. Administrators, surgeons and non-anesthesia personnel view anesthesia as a "cost." Furthermore, there is a view that money should be made on the backs of anesthesia. We're not getting rich. But I can promise that the lights go out in a room when anesthesia is absent. These sentiments and experiences have shifted anesthesia providers into temporary settings at greater cost to everyone involved.
Robert Gordon, MD. Anesthesiologist in Ramsey, N.J.: This type of maneuver is nothing new. "Managed care" has existed for 25 years. Companies will continue to scheme.
Matthew Gummerson, MD. Anesthesiologist in Dallas: I don't think this was a broader policy shift or statement as to anesthesia reimbursements across the board but an experiment to explore what the possible fervent reactions might be from the anesthesia community. It was significant.
Calvin Johnson, MD. Professor of Anesthesiology at Cedars-Sinai Medical Center (Los Angeles): While it's tempting to view this reversal as a broader shift, it's more likely to be a response to specific pressure from stakeholders in this instance. That said, this could set a precedent for how payer policies are crafted and revised in the future. If other payers observe that collaborative dialogue and adaptation improve outcomes for all parties, we may see a more balanced approach to anesthesia reimbursement policies industry-wide. The key takeaway is that provider advocacy and data-driven evidence remain essential tools in shaping fair reimbursement practices.
Bob Johnstone, MD. Chair of the Department of Anesthesiology at West Virginia University (Morgantown): Insurers seem more driven by profits than helping patients. They will probably look for new ways to reduce payments and increase their profits. Physicians are more wary now, but whether they can keep their payments seems uncertain.
John Kezele, CRNA. Certified registered nurse anesthetist at Franklin County Medical Center (Preston, Idaho): In the face of rising costs, including wages, I find payers are reducing payments, including an additional 15% because I am an independent functioning anesthesia provider. Anthem's policy was just another cost-saving tactic to help define a "failed market." They aren't the only ones. CMS has been doing the same.
Mike MacKinnon, DNP, CRNA. Owner of Mackinnon Anesthesia (Show Low, Ariz.): I think this is a one-off based on current events and anti-commercial insurance sentiment. I fully expect this to come back. These types of policies place unnecessary burdens on both patients and providers, seemingly designed to frustrate the process of payment until someone gives up. Starting in January 2025, two major commercial insurers will reduce CRNA reimbursement rates by an additional 15%. Now, some insurers are introducing arbitrary caps on reimbursable anesthesia time, regardless of how long a case actually takes.
This policy unfairly penalizes anesthesia providers for circumstances beyond their control. Surgeons are reimbursed the same regardless of case duration, while anesthesia is penalized for prolonged surgical times caused by inefficiency, unavoidable complications, or delays for essential steps such as sterilizing instruments or waiting on pathology. These issues are intrinsic to the operating room environment, yet anesthesia providers are singled out financially. This devaluation of anesthesia services is a direct affront to the expertise and vigilance required to keep patients safe throughout the perioperative period.
The ripple effects of such policies extend beyond the operating room. Groups employing anesthesia providers will inevitably turn to hospitals for increased subsidies, and hospitals employing anesthesia will face higher operating costs as the gap between collections and salaries widens. In a competitive market, salaries for anesthesia providers will not — and should not — fall simply because insurers have decided to prioritize profits over patient care. Meanwhile, the CEOs of these for-profit insurers continue to receive massive bonuses and salaries, further highlighting the disparity between their corporate interests and the realities of providing quality healthcare. It is crucial to remember that commercial insurance companies are not in the business of healthcare — they are in the business of profit.
Matt Mazurek, MD. Assistant Professor of Anesthesiology at Yale School of Medicine (New Haven, Conn.): Anesthesiologists and CRNAs have enormous leverage. Anesthesia services are currently in great demand, and that demand is outstripping supply. Insurance companies are treating anesthesia services as a cost center to be exploited, and this is not an accident because CMS has been reimbursing our services far below our true market value for decades. Around 57% of anesthesiologists are over 55 years old, and 50% of CRNAs are over 50 years old. These numbers are facts. A good percentage of these providers are over 60 and can retire at any time. Any attempt by insurance companies to propose this kind of reimbursement scheme will be met with the same response. The optics are exceptionally poor, and I am sure patients who are examining Medicare Advantage plans are considering what Anthem just proposed. In fact, the governors of New York and Connecticut contacted Anthem directly about the consequences of this proposal. Unfortunately, I am certain that there will be continued pressure to reimburse us less in order to maximize profits and shareholder value. A for-profit insurance company’s fiduciary responsibility is to maximize shareholder value. I have a different value system, and I am certain my colleagues and any healthcare system will oppose any efforts to devalue the professional, highly skilled services anesthesiologists and CRNAs provide. For those patients considering insurance options, caveat emptor.
These opinions are solely my opinion and not those of Yale School of Medicine or Yale New Haven Health.
Udaya Padakandla, MD. President of the Texas Society of Anesthesiologists: I can't read the insurers' minds, but I do sincerely hope this decision to rescind such a capricious policy gets the insurers to really rethink their policies on making profits for their shareholders at any and every expense. They have been systematically chopping down payments to physicians, and unjustly denying services to patients by implementing draconian pre-authorization requirements (another greedy attempt at maximizing profits). They do need to take a step back and see for themselves how far they have taken the profit motive in healthcare markets. The healthcare market is NOT the goose that lays the golden egg.
This also brings up a thought in my mind. I always wondered why only physicians are beholden to the Hippocratic oath. In fact such an oath, "to NOT harm the patient (and the physician that takes care of the patient)" should be instituted for every entity that steps into the arena of healthcare — be it a facility, ASC/hospital, nursing home, PBM, GPO or an insurance carrier. After all, health — and healthcare by extension — have been turned into commodities on Wall Street, to the detriment of our own population. Profit needs to take a back seat where health and lives are involved. That is a better way forward for civilized societies.
Stan Plavin, MD. Anesthesiologist and owner of Oral Surgery Anesthesia Associates: I do think it is possible that Anthem and other carriers are always looking for ways to control the narrative and the payment models. After all, physician care and services are what patients appreciate most — Anthem and other carriers should spend more time and energy making sure physician-directed care is compensated more than reckless spending on dietary medications or unproven chemotherapeutic agents. For the carriers and most people, it is always a balance between time and money. Focus on preserving the physician-patient relationship and the rest will hopefully take care of itself. Looking at various payment models may work, but have a robust discussion and engage the physician groups accordingly; don't randomly try to pull a fast one.
Rick Richter, MD. Anesthesiologist at Anesthesia Associates of Rock Hill (S.C.): I believe this approach to alter the methodology of paying for anesthesia services is only one of several facets that will attempt to force anesthesiology to become a wholly integrated service for surgical reimbursement in a misguided effort to ratchet down costs in order to improve profits for insurance companies.
James Stockman, MSN, CRNA. Past President of the Texas Association of Nurse Anesthetists and CEO of Grasshopper Anesthesia Services: Sadly, I feel this is an isolated incident due to significant negative feedback from stakeholders such as the American Association of Nurse Anesthesiology (who I know voiced significant opposition behind the scenes on the decision) and the American Society of Anesthesiologists, who was more public. This, combined with significant opposition from the public, seems to be what caused the reversal. What gets lost in these discussions on anesthesia cuts (Medicare has decreased reimbursement over 8% in the last four years) is that the costs are passed on to hospitals and patients. This is particularly hard on rural hospitals, which are already significantly financially stressed. Our country desperately needs to have a wider conversation on the decreasing anesthesia reimbursement versus the increasing demand for CRNAs and anesthesiologists.
Gerald Szelagowski, MD. Anesthesiologist at Buckeye Anesthesia Services and Consultants (Lima, Ohio): Insurance companies make money by not paying out claims. This is an example of the extreme limits that these multibillion -dollar companies will push their paying customers and contracted providers. This is not the end.…
Jeff Tieder, MSN, CRNA. Clinical Associate Professor at the University of Tennessee at Chattanooga: I do hope that reimbursement for anesthesia services will continue to be valued. As an anesthesia provider and CRNA faculty, I believe that an efficiency-driven model of provider is the only real way to navigate the current and future provider shortage. Insurance companies that devalue the role of CRNAs in the community do a disservice to their clients and the providers who serve them. Incentivizing surgeons that stay within the "normal time" and quality for routine procedures would have a better impact than decreasing anesthesia fees.
Jay Weller, MD. Anesthesiologist at Seven Hills Anesthesia (Evendale, Ohio): Anthem BCBS is not unique, but this is not the first time they have attempted unilaterally to completely rewrite the rules for how anesthesia services are reimbursed. They did it successfully in 2012, when they became the only insurer to abandon the standard base plus time model and convert to paying a flat fee for anesthesia for endoscopy services. They failed in an effort to deny reimbursement for anesthesia for cataract surgery in 2018 and have failed again in their effort this time. Based on this history, it appears that Anthem has a strategy of trying to rewrite the rules unilaterally every five years. Recently, other insurers have also begun to implement unilateral efforts to rewrite the norms that have defined reimbursement for anesthesia services for more than 30 years. Unfortunately, the insurance industry is highly concentrated, which will undoubtedly encourage carriers with dominant market positions to continue to look for creative ways to maximize profits at the expense of patient care.