5 ms·

Anthem drops controversial new plan to cap anesthesia coverage after backlash

47 points by donsupreme 2y ago

readthenotes1 2y ago
I'm guessing they were worried someone might die
- MoreMoore 2y ago
  I'm sure they were very worried about their patients.
  - baq 2y ago
    They're probably very worried about their patients' children with backpacks of monopoly money.
- deleted 2y ago
  [deleted]
ndsipa_pomu 2y ago
Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.
- Spooky23 2y ago
  Any sensible thing can be discarded in the name of freedom. Any improvement is communism.
- bushbaba 2y ago
  The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%. The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease. The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middle-parties, ..etc all would allow the Us to get more care for money they spend. Also do realize the U.S. doesn’t have healthCARE but health INSURANCE. Insurance is geared towards covering unexpected large cost events. Americans use their health insurance as health care.
  - lotsofpulp 2y ago
    Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years: https://www.macrotrends.net/stocks/charts/ELV/elevance-health/profit-margins https://www.macrotrends.net/stocks/charts/ELV/elevance-healt... It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins. Although, this doesn’t take away from the fact that MCOs have been getting away for too long with criminal prior authorization practices that waste a lot of people’s time (and health). But I bet fixing this would involve spending a lot more on labor, which people also would not like (higher premiums/deductibles/taxes).
    - ImPostingOnHN 2y ago
      > It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins Hilarious!!! Or it would be, if making margins by denying lifesaving care, weren't totally different from making margins on a bag of juice.
      - lotsofpulp 2y ago
        Why is that relevant? The important piece of information is operating a business at low profit margins is hard (obviously because a zero or negative profit margin is a charity and not a business). People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more competitive pressure is funny, because they obviously would have no better solution than what the executives of the business barely eking out a profit are doing. And on top of that, all insurance pricing has to be approved by the government. The conclusion is only that people like to complain. They complain about high premiums/deductible, they complain about prior authorizations, they complain about fraud, they complain about denied coverage. And then they will still choose to purchase from the company offering the lowest premiums.
        2y ago
- lotsofpulp 2y ago
  The government itself is who came up with the anesthesia guidelines and what the government will and will not pay for if someone’s healthcare is paid by the government (Medicare/Medicaid/etc): https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf https://www.cms.gov/files/document/chapter2cptcodes00000-019... But that is one the purposes of the managed care organizations (MCOS, aka health insurers). They take the heat off the politicians for reducing quantity and quality of healthcare, because pay has been going down for 10+ years for doctors. In the UK, it is easy for people to blame the government for long wait times or less credential provider, since the government is directly offering it. But US leaders are in a better position, they can cut remuneration via myriad billing code changes and prior authorization policies, and people’s eyes will glaze over before they get to the end of this paragraph.
ryaniscool 2y ago
Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not seem proportional to the work they do. I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.
- crawftv 2y ago
  There is a specific type of nurse called a CRNA that is basically a replacement for anesthesiologists. And half the nurses I know are going to school for that. It seems like hospitals and insurers want to replace the MD here.
- jauntywundrkind 2y ago
  Just passing along some heresay here... I'm not fit to judge but this thread does have some support if trying to reel in anesthesiologist billings. Second hand report of an anesthesiplogist being in support of BCBS trying to limit unneeded expenses. https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxjewc2n https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxje...
- anotherhue 2y ago
  Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place. ACA needs 2 sequels before anything resembling a market can emerge.
  - lotsofpulp 2y ago
    Everyone is free to buy whatever insurance they want. But they won't be able to pay for it with pre-tax income like their employer is able to. It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.
filoeleven 2y ago
> "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." Additionally, according to Vox, > Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...
- lr1970 2y ago
  An Anesthesiologist does not determine the duration of an operation. It depends on the type of operation, how sick the patient is and how fast or slow is the surgeon. Anesthesiologist provides anesthesia for the full duration of the surgery. You cannot blame an anesthesiologist for a surgery than runs extra two hours because surgeons need extra time. It makes no sense.
  - tzs 2y ago
    They were going to still pay for longer than normal procedures. It was just that it would have to be shown than the overtime was medically necessary. The time they were going to allow before justification was required is the same time the Medicare uses for deciding how much to pay.
    - lr1970 2y ago
      > was just that it would have to be shown than the overtime was medically necessary. And then the insurance paid medical adjudicators will find it "not medically necessary". And the vicious cycle continues -- deny, delay, defend.
- ImPostingOnHN 2y ago
  "don't worry, we were going to screw over a different innocent victim, not you, so we're cool right?"

47 points by donsupreme 2y ago

readthenotes1 2y ago

I'm guessing they were worried someone might die

MoreMoore 2y ago
I'm sure they were very worried about their patients.
- baq 2y ago
  They're probably very worried about their patients' children with backpacks of monopoly money.
deleted 2y ago
[deleted]

ndsipa_pomu 2y ago

Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.

Spooky23 2y ago
Any sensible thing can be discarded in the name of freedom. Any improvement is communism.
bushbaba 2y ago
The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%. The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease. The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middle-parties, ..etc all would allow the Us to get more care for money they spend. Also do realize the U.S. doesn’t have healthCARE but health INSURANCE. Insurance is geared towards covering unexpected large cost events. Americans use their health insurance as health care.
- lotsofpulp 2y ago
  Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years: https://www.macrotrends.net/stocks/charts/ELV/elevance-health/profit-margins https://www.macrotrends.net/stocks/charts/ELV/elevance-healt... It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins. Although, this doesn’t take away from the fact that MCOs have been getting away for too long with criminal prior authorization practices that waste a lot of people’s time (and health). But I bet fixing this would involve spending a lot more on labor, which people also would not like (higher premiums/deductibles/taxes).
  - ImPostingOnHN 2y ago
    > It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins Hilarious!!! Or it would be, if making margins by denying lifesaving care, weren't totally different from making margins on a bag of juice.
    - lotsofpulp 2y ago
      Why is that relevant? The important piece of information is operating a business at low profit margins is hard (obviously because a zero or negative profit margin is a charity and not a business). People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more competitive pressure is funny, because they obviously would have no better solution than what the executives of the business barely eking out a profit are doing. And on top of that, all insurance pricing has to be approved by the government. The conclusion is only that people like to complain. They complain about high premiums/deductible, they complain about prior authorizations, they complain about fraud, they complain about denied coverage. And then they will still choose to purchase from the company offering the lowest premiums.
      - 2y ago
lotsofpulp 2y ago
The government itself is who came up with the anesthesia guidelines and what the government will and will not pay for if someone’s healthcare is paid by the government (Medicare/Medicaid/etc): https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf https://www.cms.gov/files/document/chapter2cptcodes00000-019... But that is one the purposes of the managed care organizations (MCOS, aka health insurers). They take the heat off the politicians for reducing quantity and quality of healthcare, because pay has been going down for 10+ years for doctors. In the UK, it is easy for people to blame the government for long wait times or less credential provider, since the government is directly offering it. But US leaders are in a better position, they can cut remuneration via myriad billing code changes and prior authorization policies, and people’s eyes will glaze over before they get to the end of this paragraph.

ryaniscool 2y ago

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not seem proportional to the work they do. I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.

crawftv 2y ago
There is a specific type of nurse called a CRNA that is basically a replacement for anesthesiologists. And half the nurses I know are going to school for that. It seems like hospitals and insurers want to replace the MD here.
jauntywundrkind 2y ago
Just passing along some heresay here... I'm not fit to judge but this thread does have some support if trying to reel in anesthesiologist billings. Second hand report of an anesthesiplogist being in support of BCBS trying to limit unneeded expenses. https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxjewc2n https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxje...
anotherhue 2y ago
Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place. ACA needs 2 sequels before anything resembling a market can emerge.
- lotsofpulp 2y ago
  Everyone is free to buy whatever insurance they want. But they won't be able to pay for it with pre-tax income like their employer is able to. It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.

filoeleven 2y ago

> "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." Additionally, according to Vox, > Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...

lr1970 2y ago
An Anesthesiologist does not determine the duration of an operation. It depends on the type of operation, how sick the patient is and how fast or slow is the surgeon. Anesthesiologist provides anesthesia for the full duration of the surgery. You cannot blame an anesthesiologist for a surgery than runs extra two hours because surgeons need extra time. It makes no sense.
- tzs 2y ago
  They were going to still pay for longer than normal procedures. It was just that it would have to be shown than the overtime was medically necessary. The time they were going to allow before justification was required is the same time the Medicare uses for deciding how much to pay.
  - lr1970 2y ago
    > was just that it would have to be shown than the overtime was medically necessary. And then the insurance paid medical adjudicators will find it "not medically necessary". And the vicious cycle continues -- deny, delay, defend.
ImPostingOnHN 2y ago
"don't worry, we were going to screw over a different innocent victim, not you, so we're cool right?"