When Time is Money: How Anthem’s New Anaesthesia Policy Endangers Patients and Burdens Providers
How Anthem’s New Policy Puts Profits Over Patients—and Why We Must Fight Back
Anthem Blue Cross Blue Shield, one of the largest health insurers in the United States, covering millions of Americans across 14 states, has announced a deeply troubling policy change. Starting 1 November 2024 (as in, last month), the insurer will cap reimbursement for anaesthesia services based on standardised time values established by the Centers for Medicare & Medicaid Services (CMS). These CMS time values are averages meant to guide Medicare reimbursement, not rigid limits for complex medical care. By applying these benchmarks universally, Anthem is creating a system that ignores the complexities of surgical procedures and the individual needs of patients, leaving anaesthesiologists uncompensated for time spent beyond these arbitrary caps. Given Anthem’s substantial market share, this policy has the potential to disrupt care on a national scale.
This change prioritises corporate cost-cutting at the expense of patient safety and provider sustainability. Anaesthesia is not a one-size-fits-all service; it is a dynamic and highly individualised process requiring continuous monitoring and adjustments tailored to each patient. The time needed for anaesthesia often exceeds standard benchmarks for surgeries involving unique complexities, such as gender-affirming procedures for trans individuals or dental and minor surgeries for autistic people, who may require general anaesthesia due to sensory or behavioural needs. Anthem’s rigid caps could dissuade providers from taking on these cases, increase out-of-pocket costs for patients, or even compromise the quality of care delivered.
The stakes are enormous. As one of the largest players in the US healthcare system, Anthem’s policies influence both patient access and the broader direction of healthcare standards. By capping anaesthesia reimbursement, the company risks eroding the principle of equitable care, disproportionately affecting vulnerable populations and further embedding profit motives into the delivery of essential medical services.
What is the New Policy?
Anthem Blue Cross Blue Shield’s new policy imposes a hard cap on anaesthesia reimbursement, tying it to standardised time values created by the Centers for Medicare & Medicaid Services. These time values, designed as rough estimates for Medicare billing purposes, are now being used as rigid limits for reimbursement by Anthem. Effective beginning last month, if anaesthesia care for a procedure exceeds these predetermined limits, providers will not be reimbursed for the additional time. This change applies across several states where Anthem operates, including major markets like New York, Connecticut, and Missouri. Whilst there are limited exclusions for patients under 22 and those receiving maternity care, the vast majority of surgical patients will fall under this new policy.
What makes this particularly concerning is the lack of mainstream attention it has received. Despite the significant impact this policy could have on both patients and providers, it has gone largely unnoticed outside of specialist circles. Not being a customer, I first became aware of this issue when a subscriber reached out, asking for my thoughts on Anthem’s decision as it relates to autism. Recognising the gravity of the situation, I’ve put together this article as a “bonus” piece to address what couldn’t possibly fit in an email reply.
Anthem’s policy sets a dangerous precedent, transforming CMS averages into an inflexible framework that fails to account for the complexities of real-world care. This hard cap creates significant risks for patient safety and financial strain for providers, particularly in lengthy or complex surgeries that simply cannot conform to these arbitrary limits. By bringing this to light, my hope is to raise awareness of the broader implications of Anthem’s decision and its potential to reshape anaesthesia care across the US healthcare system.
Who Will Be Affected?
Anthem’s new anaesthesia reimbursement policy will have wide-ranging consequences, but its impact will be most keenly felt by certain populations, particularly trans individuals, autistic people, and others requiring longer or more complex procedures. These groups already face significant barriers in accessing equitable care, and this policy risks exacerbating those challenges.
For trans individuals, nearly every gender-affirming surgery falls into the category of complex, highly individualised procedures. Surgeries such as vaginoplasty, phalloplasty, and chest reconstruction often require extended durations under anaesthesia to ensure the best possible outcomes. Revision surgeries, which are sometimes necessary to address complications or refine results, can be even more time-intensive. Anthem’s hard cap on anaesthesia time disregards the fundamental reality that these procedures cannot—and should not—be rushed. You can’t simply set a timer and expect a one-size-fits-all solution for surgeries that involve meticulous planning and execution tailored to the patient’s unique anatomy and goals. By limiting reimbursement for these procedures, Anthem risks discouraging providers from taking on complex cases, creating financial strain for patients, or both.
For autistic individuals, the stakes are just as high but manifest in different ways. Many autistic people require general anaesthesia even for procedures typically handled with local anaesthesia or twilight sedation due to sensory sensitivities, anxiety, or communication barriers. As someone who has experienced the complications of an autistic nervous system during sedation, I can attest to how unpredictable these situations can be. Despite clear notes on my chart, I’ve had severe panic attacks going into or coming out of twilight sedation during procedures ranging from wrist reconstruction to colonoscopies. These incidents terrify surgical teams and can prolong recovery times, yet they remain difficult to predict or control. The rigid time limits imposed by Anthem’s policy fail to account for these additional complexities, which can require more time for preparation, monitoring, and recovery.
Beyond these groups, the policy also poses risks to elderly patients and those with comorbidities, who often require prolonged surgical and anaesthetic care. High-risk patients undergoing intricate surgeries—whether cardiac, neurosurgical, or orthopaedic—may need anaesthesia times well beyond the CMS benchmarks. These procedures don’t fit neatly into average durations and often involve unforeseen challenges that demand flexibility and patience. Anthem’s decision to cap reimbursement creates an untenable situation where providers may be financially disincentivised to spend the necessary time on such cases, leaving patients to bear the brunt of these limitations.
This policy’s rigid framework ignores the realities of human diversity and the complexities of modern medical care. By enforcing arbitrary caps, Anthem is effectively placing profit margins above the needs of those who rely on anaesthesia for safe, effective treatment, further marginalising already vulnerable populations.
Why is This Policy Problematic?
Anthem’s new policy on anaesthesia reimbursement is deeply problematic for several reasons, each of which highlights the disconnect between rigid bureaucratic limits and the complexities of real-life medical care. At its core, the policy relies on CMS time values that are designed as averages—not precise measures—for typical procedures. These averages, by definition, represent only a midpoint in a distribution of possible surgical durations. However, if half of the previously completed surgeries—those that exceed the capped time limits—are no longer performed or are shifted elsewhere, the remaining data will skew the averages lower and lower over time. This creates a compounding effect: the more surgeries are forced to conform to artificially low limits or are abandoned altogether, the more the benchmarks themselves will fail to reflect the true range of surgical durations. Over time, this feedback loop will further entrench the system’s inability to accommodate real-life medical complexities, disproportionately affecting patients who require longer or more specialised care.
Patient safety is also at risk under this policy. The pressure to conform to time caps may lead to rushed procedures or reduced anaesthesia care, compromising surgical outcomes and recovery. Providers, already strained by financial constraints, may become less willing to accept complex or lengthy cases, leaving patients with fewer options for care. For trans individuals undergoing gender-affirming surgeries or autistic patients requiring extended anaesthesia management, these time limits could result in fewer providers willing to handle their cases—or surgeries being cut short due to financial concerns.
The financial burden this policy creates is equally concerning. Providers may need to pass unreimbursed anaesthesia costs directly to patients, complicating pre-surgical planning. Imagine sitting in a consultation and being told, “If your surgery goes longer than X hours, you’ll be charged Y dollars per additional minute.” Surgery is not a place for a “not to exceed” contract—medical procedures are inherently unpredictable, and complications can arise through no fault of your own. Now consider the financial devastation that could follow if something goes seriously wrong during your surgery, necessitating additional time under anaesthesia. The ticking clock could lead to unexpected and catastrophic costs, leaving you financially ruined for circumstances entirely beyond your control. This additional layer of uncertainty not only deters patients from seeking necessary care but also creates an untenable situation where life-saving or essential surgeries become a financial gamble.
Finally, the disparities this policy will exacerbate cannot be ignored. Marginalised groups, including trans, autistic, and disabled individuals, often require longer and more specialised care that falls well outside CMS benchmarks. By tying reimbursement to these rigid caps, Anthem places these patients at a greater risk of receiving substandard or incomplete care—or no care at all. The policy disproportionately impacts those already struggling within the healthcare system, widening existing gaps in access and equity.
Anthem’s anaesthesia reimbursement policy, though framed as a cost-containment measure (more like a profit protection measure), is ultimately a blunt instrument that prioritises profit over patient safety, fairness, and quality of care. Its ripple effects will be felt most acutely by those who can least afford them, turning medical necessity into a financial gamble.
Anthem’s Motivations
Anthem’s new anaesthesia reimbursement policy is a clear example of profit-driven priorities in the for-profit healthcare industry. Like other major insurers, Anthem’s primary allegiance is to its shareholders, not its patients. By capping reimbursement for anaesthesia services based on arbitrary time limits, the company achieves significant cost savings (profit protection), shifting the financial burden of care onto providers and patients. This strategy fits neatly into capitalism’s well-worn playbook: “socialise costs, privatise profits.” Providers are left absorbing the unreimbursed time and resources needed to deliver quality care, whilst patients may face steep out-of-pocket expenses for surgeries that exceed the cap. Meanwhile, Anthem retains higher margins, further enriching executives and shareholders at the expense of everyone else.
This move is particularly concerning given the history of consolidation in the US healthcare industry. Decades of mergers and acquisitions have created a handful of powerful oligopolies that dominate the market, leaving consumers with little choice when it comes to insurance. This lack of competition makes it easier for companies like Anthem to implement policies like this with minimal resistance—patients and providers alike have nowhere else to turn. The timing of this change, just after most open enrolment periods in early autumn, further underscores the strategic nature of the decision. Most consumers are now locked into their plans for the year, effectively eliminating any possibility of switching insurers in response to this policy.
Perhaps the most dangerous aspect of Anthem’s decision is the precedent it could set. If this policy succeeds without significant backlash, it’s highly likely that other insurers will adopt similar anaesthesia caps. The cascading effect would result in a broader industry shift toward rigid time-based reimbursement, eroding the quality of care across the board. This possibility is enormous in its implications: not only would it normalise cost-cutting at the expense of patient safety, but it could also embolden insurers to implement further limitations on coverage in other areas of care.
Anthem’s policy is a troubling reminder of the systemic flaws in for-profit healthcare. When corporate interests dominate, patients and providers bear the brunt of the consequences. The healthcare industry in the US has long prioritised profits over people, but this policy takes that ethos to a dangerous new level. By using its market dominance to force through such a change, Anthem risks not only the wellbeing of its own policyholders but also the broader integrity of the healthcare system. Without significant pushback, this could mark the beginning of a new wave of exploitative policies, with insurers continually seeking ways to maximise profits at the expense of those they are meant to serve.
How Does This Affect Healthcare Providers?
Anthem’s new anaesthesia reimbursement policy places significant operational pressure on healthcare providers, particularly anaesthesiologists, who are already stretched thin in many parts of the country. The hard cap on reimbursement time forces providers to make impossible choices: either reduce the time and care they dedicate to patients, potentially compromising outcomes, or absorb the financial losses when procedures exceed the arbitrary limits. Neither option is sustainable. For many anaesthesiologists, this may mean rejecting complex or high-risk cases altogether, leaving patients without access to care for surgeries that demand more time and resources than the policy allows.
The impact on hospital systems could be severe, particularly in states where anaesthesiologist shortages are already critical. Across the United States, the demand for anaesthesia services far exceeds the supply of qualified professionals, with some estimates projecting a shortage of nearly 12,500 anaesthesiologists by 2033. Rural and underserved areas (like mine) are particularly vulnerable, often relying on a small number of practitioners to meet the needs of entire regions (I have an hour’s drive to the nearest surgery centre). Anthem’s policy exacerbates this problem by creating disincentives for anaesthesiologists to practice in these areas, where complex cases and longer procedure times are common. If providers feel they cannot be fairly compensated for their work, they may opt to leave the field altogether or relocate to states or systems with more equitable policies.
The ripple effects will extend beyond anaesthesiologists to the entire healthcare system. Hospitals already grappling with staff shortages may find it increasingly difficult to recruit and retain anaesthesia professionals, leading to longer wait times, delayed procedures, and reduced capacity to handle emergencies. Anthem’s policy, far from addressing healthcare inefficiencies, compounds an already dire situation, threatening the stability of a system that millions of patients depend on for life-saving care.
Final thoughts …
Anthem’s new policy is a wake-up call for anyone who values equitable healthcare. Patients and providers alike must take action to push back against a system that increasingly prioritises profit over care. For patients, this begins with understanding how the policy might impact them personally. Contact your healthcare providers to discuss whether your planned procedures could be affected. Ask direct questions about how time limits on anaesthesia might influence the cost and quality of your care. Beyond this, advocate for greater transparency in insurance policies and hold insurers accountable by filing complaints with your state insurance commission. These small but meaningful steps can help build pressure for change.
Providers, too, have a critical role to play. Collective advocacy is essential to counter the influence of insurers like Anthem. Organisations such as the American Society of Anesthesiologists (ASA) are already working to oppose this policy, and they need support from medical professionals and institutions. Educating patients about the risks of these changes can also create a stronger, more informed base of opposition. When patients and providers stand together, they can create a unified voice demanding that healthcare policies prioritise people over profits.
This policy is not an isolated incident but part of a larger trend in the healthcare industry, where unchecked corporate influence is eroding the principles of equitable care. The relentless drive to maximise profits is increasing financial strain on patients and providers, while access to necessary care becomes more uncertain. If left unchallenged, Anthem’s decision could set a dangerous precedent, paving the way for similar policies across the industry.
Yet, there is reason for hope. Collective action has the power to push back against these harmful practices. By raising awareness, advocating for policy changes, and holding insurers accountable, we can fight to protect the integrity of our healthcare system. The stakes are too high to remain silent—this is a fight we cannot afford to lose.