Following last week's reversal of Anthem Blue Cross Blue Shield’s decision to cap anesthesia coverage at a time limit, some here in Connecticut are calling for changes in how insurance companies change coverage.
Anthem had announced the new policy last month. They told patients that they were going to change how billed time is evaluated starting Feb. 1, 2025. The insurance company said policyholders could file a claim dispute if they disagreed with a claim reimbursement decision.
The decision would have capped coverage of anesthesia after a set time limit.
In a letter to State Senator Jeff Gordon back on Nov. 22, when he questioned Anthem about the policy change, they indicated twice the policy change would be excluded from Connecticut.
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But in a statement from the American Society of Anesthesiologists, Connecticut was grouped in with Missouri and New York.
Last week, Anthem blanket reversed the rollout of the policy, offering a statement that read, “There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change."
"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 statement continued.
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Now, ahead of the legislative session set to begin on Jan. 8, Gordon is preparing legislation to limit insurance companies’ abilities to change policy without public input.
“I’m not trying to make it difficult for insurance companies, but I am very mindful that we need to keep patients over profits,” Gordon said in an interview Monday.
He is calling for transparency following last week's scare.
“The public needs to know, and the public voice needs to be heard,” he said.
His goal is bipartisan legislation to limit policy changes without a public process. He noted that ideally, the public process for input would be overseen by the Connecticut Department of Insurance.
“Instead of a unilateral change by insurance companies, it has to be approved,” Gordon said.
The public process would trigger if an insurance company operating in Connecticut sought to change a policy like this anesthesia example, but also a change to healthcare networks and medication coverages.
His colleague across the aisle and fellow doctor, Saud Anwar, likes the idea.
“We cannot have an insurance executive wake up in the morning and say, 'I want to change this', and 'I want to stop payment for that,' this heavy handedness needs to stop,” Anwar said.
He is on board with pushing insurance companies to require public hearings on policy changes, but notes state legislators’ power is limited in the realm of insurance policy.
He called for either more power to the states to increase regulation, or for his colleagues in Washington to step up to the plate, because he, too, wants to see change.
“For them to say 'money first' doesn’t work for us,” Anwar said.
Gordon believes this is a step locally, in checking the power of insurance giants.
“Even the playing field for patients, the people of Connecticut,” Gordon said.
NBC Connecticut has reached out to Anthem Blue Cross Blue shield for comment regarding potential legislation, but has not heard back.
