I don’t know why someone gunned down the CEO of UnitedHealthCare on Wednesday morning in front of a midtown Manhattan hotel. But I wouldn’t be shocked if it tracks back to some denial of coverage issue. When they apprehend the suspect, who escaped into Central Park on a rented CitiBike, we may learn more. Of course, this is a murder and there are no excuses that will justify it. But sometimes these health insurance executives make their own unjustifiable decisions.
For example, Anthem Blue Cross Blue Shield just came out with a real head-scratcher.
In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes. The American Society of Anesthesiologists calls on Anthem to reverse this proposal immediately…
…Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards. With this new policy, Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem’s limit, Anthem will deny payment for the anesthesiologist’s care. With this new policy, 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.
Let’s start with something simple. You never want to incentivize a health care professional to put speed over quality. With this policy, an anesthesiologist has to worry that too much preoperative time spent on a patient could result in loss of payment if the surgery goes longer than expected, and that any postoperative care may not be compensated. This is a perverse incentive that puts patients at risk, and not just financially.
But the financial part is significant, too. Patients with health coverage may nevertheless see huge bills they cannot pay, and so poor patients without collateral could be denied care or get rushed and substandard care as a result.
No doubt the policy change will help Anthem make more in profit. They’ve been doing quite well in that area: “In June 2024, Elevance Health, the corporate name for Anthem,reported a 24.12% increase in its year-over-year net income to $2.3 billion and a 24.29% increase in its year-over-year net profit margin.”
They should probably expect to pay more out in lawsuits, as patients or their surviving families look for redress for preventable injuries and deaths. But I suppose they’ve factored that in and figured they’ll still come out ahead. This is going to make some people very angry, and perhaps they didn’t do enough to factor that aspect into their decision.
