A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
Behind every denial letter, there’s a story. A cancer patient forced to delay life-saving treatment, a parent battling red tape to secure the recommended therapy for their child who must “fail” the cheaper alternative first, a person with diabetes rationing medication because their insurer refused to cover the full cost, or a patient wondering whether their insurance will cover their anesthesia during a colonoscopy. These aren’t isolated incidents. They’re lived experiences, which have been covered in stories by a myriad of news outlets, of countless Americans caught in a system where profits take precedence over patients.
I, like you, have seen this firsthand, over and over. As president of the American Society of Anesthesiologists (ASA), I’m joined by our members and other medical societies who have long sounded the alarm on bad insurance company behavior. Patients are also fed up, and social media is filled with stories of personal struggles and frustrations with high costs, denied claims, and bureaucracy. Just as we solve complex problems in the operating room, anesthesiologists are advocating to solve these issues and call on health insurance companies to make – and keep – the following New Year’s resolutions as a show of good faith:
- Prioritize patient care over corporate profits.
- Promise to halt all efforts to limit necessary care for patients, including limiting the duration of anesthesia care.
- Acknowledge the unique needs of patients with health conditions and risk factors—like high blood pressure, significant heart disease, or uncontrolled diabetes—and support the physicians who care for them.
- Commit to respecting the physician-patient relationship and reforming prior authorization systems that undermine physician expertise and directly limit patient care.
- Work with anesthesiologists and other physicians, not against them, to improve access to care.
Following through on these resolutions would help turn the tide on the current system, which requires health care professionals and patients to constantly battle to overcome insurance company obstacles to get needed, and often life-changing or lifesaving care. On rare occasions, insurance companies will change a restrictive policy, but only after it receives significant negative attention from patients, the public, and health care professionals. This happened recently when Anthem Blue Cross Blue Shield proposed a policy to predetermine an arbitrary time limit for anesthesia services in several states and cover care for only that period, regardless of how long the procedure needed to be. ASA called on Anthem to reverse the policy immediately, and the insurance company did so only after the issue received extensive backlash and media coverage. It should not take public outcry to prevent the implementation of these types of policies.
And there are many other examples. Anesthesiologists create individualized care plans for every patient to keep them safe during surgery. Sicker patients, such as those who have uncontrolled diabetes, lung disease, or serious heart problems, are at higher risk during procedures and often need additional and more complex care to keep them safe during surgery. But now, many Blue Cross Blue Shield plans will no longer cover the extra time that caring for these vulnerable patients requires.
This reflects a larger trend among commercial health insurers to unilaterally undercut established payment norms that recognize anesthesia services and care. Recent Anthem, Blue Cross Blue Shield, Cigna, and Aetna policy changes have targeted some of the most vulnerable patients treated by anesthesiologists, including infants and those older than 70, patients who need emergency care, and those who have severe systematic diseases such as diabetes or lung disease. Prior authorization policies have also put obstacles between patient treatment and necessary, timely care. In anesthesia, this often affects our patients who suffer from debilitating chronic pain that may be treated with injection therapy and sometimes other types of procedures. These treatments may be subject to extended authorization delays, resulting in delayed care and leading to decreased mobility, poor quality of life, missed work, and emotional distress. These delays also impact physician practices trying to do the best they can for their patients while dealing with insurer-created administrative burdens, which increase staff and physician burnout. These problems can be resolved by streamlining approvals, following guidelines, and implementing processes that have reasonable time limits.
As has become abundantly clear in recent years, the health insurance industry is all about driving profit, following a business model that involves employing tactics to avoid delivering the very service it was created to provide.
Those of us in health care dedicate our careers to delivering exceptional care that helps patients lead healthier, more fulfilling lives. Yet the stories behind the denial letters reveal the significant barriers we face in achieving that mission. We urge insurance companies to join us in a shared vision: one where patients receive the timely, necessary care they deserve, guided by their physicians and health care professionals. Together, we can transform the health care system into a true success story that prioritizes patients and celebrates the life-changing impact of contemporary medical care.
Donald E. Arnold is president, American Society of Anesthesiologists.
