Anthem, one of the largest health insurance providers in the U.S., abruptly abandoned a controversial plan to limit reimbursed anesthesia time for surgical procedures. The decision came the day after the CEO of rival insurer UnitedHealthcare was murdered in broad daylight. (The timing has raised questions within the industry about whether the shocking event influenced Anthem’s decision-making.)
CBS News provides further details on the insurance giant’s sudden change of heart:
Anthem Blue Cross Blue Shield said Thursday that the health insurance provider is reversing a policy that was set to go into effect in February of that would have limited anesthesia coverage during surgeries and other procedures, a change that had prompted an outcry from some physicians and lawmakers.
The policy, which would have covered Anthem’s plans in Connecticut, New York and Missouri, was disclosed in recent weeks, with the company’s New York unit posting a notice on Dec. 1. The policy would have excluded people under 22 years old and maternity care.
According to the original policy statement, Anthem had said it would pay only for anesthesia treatments for the length of time that a procedure or surgery is estimated to require based on the Centers for Medicare and Medicaid Service’s physician work time values. The insurer noted that claims for anesthesia “above the established number of minutes will be denied.”
In an email to CBS News on Thursday, Anthem said it was backing away from the policy, and added there had been “widespread misinformation about an update to our anesthesia policy.”
“As a result, we have decided to not proceed with this policy change,” a spokesperson attempted to clarify. “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
The now-scrapped policy was reportedly part of an ongoing effort to increase profits by imposing stricter limits on reimbursements for medical procedures. Critics argued the plan would have added another layer of red tape, further restricting physician autonomy and jeopardizing patient care.
Anthem’s reputation for bureaucratic hurdles—such as denying treatments, delaying medication approvals and requiring excessive pre-authorizations—has long drawn criticism from health care providers. This latest initiative was seen by many as another move in that vein.
St. Louis’ Barnes-Jewish Hospital, ranked the 11th best hospital system in the nation, recently issued a stark warning: the system would stop accepting Anthem insurance altogether unless the company addressed persistent complaints over payment practices and delays.
While Anthem has not fully addressed the timing of its policy reversal, the abrupt decision has fueled speculation about whether the company aimed to avoid further scrutiny in the wake of its rival’s high-profile tragedy. For months, the American Society of Anesthesiologists had called on Anthem to reverse the policy, but those efforts were unsuccessful.
UnitedHealthcare CEO Brian Thompson was shot and killed in a targeted attack early Wednesday morning outside the Hilton in midtown Manhattan, where he was staying. A man wearing a dark-colored jacket, hat, ski mask and gray backpack had reportedly been lying in wait as Thompson exited the building. Investigators say the shooter left behind shell casings inscribed with the words “deny,” “defend” and “depose,” a cryptic message they believe may provide clues to the motive.
Authorities are investigating a potential connection between the inscriptions and the 2010 book Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It, which criticizes insurance industry practices. The New York City Police Department is continuing its search for the suspect and has announced a $10,000 reward for information leading to an arrest, though some have criticized the amount as wholly insufficient given the high-profile nature of the case.
For decades, U.S. health insurance companies have faced significant criticism for practices such as undercompensating doctors, complicating prior authorization processes and denying necessary treatments and medications. Notable examples include:
Undercompensation of Physicians:
UnitedHealthcare: In 2021, a Nevada jury found UnitedHealthcare guilty of “oppression, fraud, and malice” for underpaying claims to three affiliates of TeamHealth, a physician network. The jury awarded TeamHealth $62.65 million in damages.
Centene Corporation: In 2020, a jury in Arkansas determined that Centene underpaid emergency room doctors affiliated with TeamHealth, resulting in a $9.4 million award to the physicians.
Challenges with Prior Authorizations:
Medicare Advantage Plans: A 2022 report by the U.S. Department of Health and Human Services’ Office of Inspector General revealed that Medicare Advantage Organizations denied 13% of prior authorization requests that would have been approved under traditional Medicare, leading to delays or denials of necessary care.
EviCore: This medical benefits management company, contracted by insurers like Cigna and Aetna, has been criticized for issuing medical guidelines that delay or deny care. Investigations found that EviCore’s business model often incentivizes denying payments for doctor-recommended treatments.
Denial of Necessary Treatments and Medications:
Aetna: In 1999, a California jury awarded $116 million in punitive damages against Aetna for delaying approval of a doctor’s recommended treatment for a cancer patient, who subsequently died. The case highlighted the insurer’s failure to act promptly on medically necessary treatments.
Blue Cross Blue Shield (BCBS): In 2022, BCBS of Louisiana was found to have improperly denied proton therapy for a cancer patient, despite it being a nationally accepted standard of care. The court ruled that BCBS abused its discretion in deeming the treatment medically unnecessary.
These instances and others underscore systemic issues within the U.S. health insurance industry, where administrative practices can hinder patient access to essential medical care and place financial strains on health care providers.
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There are usually two reasons for murder… passion or gain. Brian Thompson was known to be critical of WHO. The United Nations is the legal arm of the Illuminati and does not tolerate anyone mudding their water. I can provide a list of murders carried out by the Illuminati, some were carefully crafted to look like accidents, as well as so-called “medical episodes.”