February 09, 2018

Anthem Policies Draw More Criticism

Anthem Blue Cross and Blue Shield’s controversial payment policies for hospital outpatient advanced imaging and anesthesia during routine cataract surgery are drawing harsh criticism on the east and west coasts.

In Virginia, the News Leader, a newspaper serving the city of Staunton, near Harrisonburg, VA, criticized Anthem for dropping local provider Augusta Health from its network and changes to several payment policies that it calls the “rawest possible deal” for its subscribers.

The paper’s editorial board highlighted the March rollout of its restrictions against reimbursement for advanced imaging services provided by hospital outpatient services in Virginia, making note of a recent letter from the American College of Radiology and 11 other medical societies and patient advocacy groups asking Anthem to end the policy.

In California, a potentially dangerous Anthem policy that denies reimbursement for general anesthesia in most cases during routine cataract surgery has sparked opposition from the California Medical Society and California Academy of Eye Physicians and Surgeons.

In a February 1 letter to California Insurance Commissioner Dave Jones, CMA called for an investigation of Anthem’s decision to designate intravenous anesthesia for cataract surgery as medically not necessary except in narrow circumstances.

CMA expressed grave concerns with Anthem’s clinical policy change expressing its belief the revision will cause significant patient safety risks up to and including blindness and conflicts with Anthem’s legal obligations under California’s insurance code to cover essential health benefits.

The California Academy of Eye Physicians and Surgeons recently expressed similar patient safety concerns in an urgent written request asking Anthem to rescind its policy.

CMA also called for state insurance departments to “investigate and confirm” if Anthem provided the required 45-business day notice before changing material terms of its provider contracts or materially amending a manual, policy or procedure document referenced in its contracts.