BCBS Updates Anesthesia Time Limit, Putting Patients on the Hook for More Costs

If you’re insured through Anthem Blue Cross Blue Shield (BCBS), heads up! The company announced on Dec. 1, 2024, that it’s making changes to how billed time units for anesthesia services are evaluated. This update will apply to claims processed on or after Feb. 1, 2025.

In the press release, the insurance provider explained that it’s not eliminating coverage for anesthesia entirely.

Instead, it’s shifting how the billed time for these services is calculated. You know, the process that helps patients get through surgical procedures safely and with less stress?

While coverage for anesthesia isn’t disappearing, the updated evaluation method could leave you footing a larger portion of the bill for these often costly services.

Here’s everything you need to know about Anthem Blue Cross Blue Shield’s updated anesthesia time limits and the key exemptions that might apply to you.

BCBS is making a big change for its Anthem policyholders. Patients will now be responsible for covering costs if anesthesia services exceed a set time limit. Essentially, if the reported minutes for anesthesia go over the established cap, BCBS will pass the bill along to the patient.

To determine these time limits, BCBS is using the Centers for Medicare and Medicaid Services (CMS) Physician Work Time values as a benchmark. CMS has published the physician fee schedule for anesthesia on its website.

Any anesthesia minutes that go beyond the allowed amount will be billed to the patient at the CMS-established rate. It’s a shift that could leave some patients paying more out of pocket for longer procedures.

The update applies to anesthesia services during the pre-service evaluations, intra-service period, and post-service period, according to BCBS. The American Society of Anesthesiologists also highlighted in a November 2024 press release that the new duration limits will impact patients in Connecticut, New York, and Missouri, although BCBS’s memo doesn’t specify these locations.

According to BCBS, the only exclusions to the updated guidelines are patients under the age of 22 and those receiving anesthesia for maternity-related care. However, it’s important to read the fine print of the new guidelines (or contact the insurer directly for clarification), as there may be other limitations that could affect individuals in either of these categories.

The updated anesthesia time limit schedule has sparked anger from many, including the American Society of Anesthesiologists, which is now calling for a reversal. The organization warns that under these new guidelines, "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."

Folks have taken to X (formerly Twitter) to voice their frustration, with one asking, "Are these people out of their minds???" Another user commented, "So it begins. American healthcare is about to become the Hunger Games." While Anthem is facing significant pushback on its latest anesthesia guidelines, it's unclear how the company will proceed in 2025 or if it will keep the policy in place.