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Anthem drops controversial new plan to cap anesthesia coverage after backlash

usatoday.com

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Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#21

Post by Teever »

ryaniscool wrote: post #9

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 s…

> 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.

https://xkcd.com/793/

Are there any countries in the world where they've replaced anesthesiologists with nurses? What's the data on outcomes for that look like?

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#22

Post by jghn »

ryaniscool wrote: post #9

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 s…

The problem is that the proposed solution made no sense. If the surgery is taking longer than expected, that is not something driven by the anesthesiologist. And yet the proposal would be complicating the billing/payment relationship of the anesthesiologist & the patient. Meanwhile the actual surgeon is not at all affected.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#23

Post by jliptzin »

ryaniscool wrote: post #9

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 s…

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause other issues/side effects but that's what I have to do if the first option won't be covered. If someone smashes into the passenger door of my car can my car insurance company just say they don't feel like paying for it because I can still get into the car through the driver side?

Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#24

Post by lr1970 »

filoeleven wrote: post #18

> "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 patien…

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.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#25

Post by ImPostingOnHN »

filoeleven wrote: post #18

> "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 patien…

"don't worry, we were going to screw over a different innocent victim, not you, so we're cool right?"

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#26

Post by ImPostingOnHN »

lotsofpulp wrote: post #11
bushbaba wrote: post #6

Earlier quoted context omitted.

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 middl…

Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years: 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…

> 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.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#27

Post by gruez »

jliptzin wrote: post #23
ryaniscool wrote: post #9

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 s…

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause…

>I don't understand why the insurance company is the one to decide when and how to cap the costs.

Because the insurance company is basically the only entity who has skin in the game.

>Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

And the response if this is all covered would be "who cares? my insurance is covering it anyways". The patient doesn't have any incentive to choose a cheaper hospital, because he won't see any of the savings.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#28

Post by tzs »

lr1970 wrote: post #24
filoeleven wrote: post #18

> "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 patien…

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.

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.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#29

Post by lotsofpulp »

ImPostingOnHN wrote: post #26
lotsofpulp wrote: post #11

Earlier quoted context omitted.

Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years: 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…

> 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.

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.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#30

Post by ryaniscool »

jliptzin wrote: post #23
ryaniscool wrote: post #9

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 s…

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause…

This is a straw man argument. Yes they shouldn't deny a prescription if your doctor says you need it.

What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year.

Here is some perspective. The anesthesiologist's bill for my wife's colonoscopy in 2023 was $2k. This is a routine procedure that takes less than an hour. Also, the place was just filled with patients and there was one guy handling them all.

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