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States Act On Threat of Insurer-Imposed Anesthesia Time Limits

Anthem BCBS policy draws attention of legislatures

BY STEPHEN ABRESCH | FEBRUARY 28, 2025

States across the country have introduced legislation seeking to prohibit attempts by insurers to impose time limits on their coverage of anesthesia services. So far this year, nine states—Connecticut, Illinois, Maryland, Missouri, New Jersey, New York, Oklahoma, Texas and Washington—have introduced 16 bills aimed at stopping such policies. This flurry of bills follows Anthem Blue Cross Blue Shield’s attempt to impose time limits on its coverage of anesthesia services last year.

Background

On November 12, 2024, the American Society of Anesthesiologists (ASA) wrote a letter to Elevance Health, Anthem’s corporate name, opposing the new policy Anthem was seeking to test in Connecticut, Missouri and New York. In a November 14, 2024, news release, ASA questioned Anthem’s “unprecedented move” of no longer paying “for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes.” In the letter, Donald Arnold, MD, president of ASA, wrote, “Based upon our reading of this proposed change, Anthem’s policy threatens to deny claims where the anesthesia practice has accurately documented the time taken to perform the anesthesia service. In general, the policy would compel anesthesia groups to report what Anthem will allow instead of the accurate clinical time.” ASA called on Anthem to rescind the policy immediately and requested a meeting by November 15.

ASA continued to sound the alarm about the policy change and began attracting the attention of lawmakers. On November 20, 2024, Jeff Gordon, Connecticut state senator, sent a letter to Anthem pressing them for answers about the time limits and calling the policy change, “contrary to providing good and safe medical care for people in Connecticut and other states.” On December 4, 2024, New York Governor Kathy Hochul and Connecticut Senator Chris Murphy both posted on X condemning the policy.

On December 5, 2024, after a deluge of bad press, criticism from clinicians and pressure from lawmakers, Anthem announced that it would not implement the proposed changes to its billed time units policy in Connecticut, Missouri and New York. Even as it announced the recission, Anthem attributed the move to a misunderstanding of the policy and unclear communication rather than the anticipated impacts of the policy itself. “There has been significant widespread misinformation about an update to our anesthesia policy,” Anthem communications across all three states read. “Based on feedback received and misinterpretation of our policy change, it is evident that our communication regarding this policy was not clear, and as a result, we have decided to not proceed with this policy change.”

State Legislation

Despite Anthem’s insistence that its policy was misunderstood, states are moving ahead with restrictions on the practice.

Unsurprisingly, the states targeted by Anthem’s policy have responded forcefully. Connecticut legislators have introduced three measures, SB 10, SB 192 and SB 814, which prohibit health insurers from imposing unilateral and arbitrary time limits on coverage for general anesthesia during any medically necessary procedures. Missouri lawmakers have introduced HB 932, HB 1126 and SB 592 that prohibit insurers from imposing time limits on the payment of anesthesia services, and New York legislators have introduced AB 5375, which would prohibit the use of arbitrary time caps on reimbursement for anesthesia services provided during medically necessary procedures.

Legislators in states not initially included in the policy also are taking proactive steps to protect residents from future attempts by insurers to limit anesthesia coverage. In Illinois, HB 1141 and SB 1488 would both require health insurance plans issued or renewed on or after January 1, 2026, to cover medically necessary anesthesia, regardless of the duration, for any procedure covered by the policy. Maryland’s HB 1086 requires insurers and managed care organizations to provide coverage for the delivery of anesthesia for the entire duration of a procedure. New Jersey AB 5288 and companion bills AB 5216 and SB 4056 prohibit insurance carriers from limiting coverage based on the amount of time in which anesthesia services are provided before, during or after a medical or surgical procedure. Oklahoma SB 1019 would prohibit insurers from imposing time limits on the amount of covered anesthesia services provided during a medical or surgical procedure, or restrict or exclude coverage or payment of anesthesia time. Texas SB 1118 mandates that health benefit plans provide coverage for the full time that anesthesia services are provided if the plan covers medically necessary anesthesia. Finally, Washington HB 1812 requires insurers to provide coverage for necessary anesthesia services for any procedure covered by the health plan, regardless of the duration of anesthesia care, and further prohibits insurers from imposing arbitrary time-based limits or any other cap on reimbursement for anesthesia services.

ASCA is tracking these and many other bills across all 50 states. Write Stephen Abresch at sabresch@ascassociation.org to learn more about state legislation impacting ASCs.