The Anthem Debacle – It Ain’t Over ‘Till It’s Over

Importantly, in its policy statements and press releases since December 5^th, 2024, Anthem has carefully avoided committing to maintaining standard payment policies for anesthesia services in the future. It is possible that Anthem, or another commercial insurer, will attempt to introduce similar payment restrictions once public attention wanes.

In response to this threat, the anesthesiology community is strengthening its defenses. The ASA is working with several state legislatures who have expressed interest in passing laws that prevent insurance companies from deviating from established standards for processing anesthesia claims. At the national level, U.S. Senators Richard Blumenthal (D-Conn) and Josh Hawley (R-Mo) are leading a bipartisan effort to investigate unfair payment policies by commercial insurers and prohibit the anesthesia payment practices as proposed by Anthem.

This story holds an important message for physicians in general and anesthesiologists in particular. The dominant model for U.S. healthcare insurance companies is now the for-profit, publicly traded national corporation. Unfortunately, market distortions in the healthcare sector make these entities nearly immune to the normal feedback mechanism of negative customer sentiment. As a result, in our opinion (and based on our collective personal experiences), it appears these entities single-mindedly pursue profit maximization without acknowledgment of customer needs. Negotiation with commercial insurers is rapidly fading. The financial viability of the medical profession and the integrity of our systems of care are now almost entirely dependent on the lawmakers and regulators who oversee these commercial payors.

If you don’t personally know anyone in your state government, it’s not too late. Call your state representative or senator. Introduce yourself and offer to serve as a resource for any questions they may have about healthcare. Build a relationship before you genuinely need one. The day you’ll need their trust and understanding may be closer than you think.

Attachment: Blumenthal Hawley Letter

~Gordon Morewood, MD, MBA, FASE, FASA

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