Anthem Anesthesia Reimbursement Changes Highlight Need for HHS to Enforce ACA Provider Non-Discrimination Provision

ROSEMONT, Ill. — The American Association of Nurse Anesthesiology (AANA) is pleased Anthem Blue Cross Blue Shield reversed its recently announced anesthesia reimbursement policy that could have endangered patients.  

“While this is a good first step, Anthem and other health insurers still have anesthesia policies that espouse blatant provider discrimination in the reimbursement for anesthesia services,” said AANA President Jan Setnor, MSN, CRNA, Col. (Ret), USAFR, NC. “These policies exacerbate provider shortages and impede access to timely, necessary healthcare services. They also have the potential to drive up costs and undermine access for patients.”  

Anthem announced last month that effective February 2025, it would deny anesthesia claims for cases that exceed the physician work time values established by the Centers for Medicare & Medicaid Services (CMS) in New York, Missouri, and Connecticut for all anesthesia providers, including Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists and nurse anesthetists. 

“CRNAs put their patients’ well-being first,” Setnor said. “We cannot ‘clock out’ when an arbitrary time limit hits. We must remain by the patient’s side not just throughout the procedure, but before and after to ensure complete recovery. It is a travesty that insurance providers do not appear to have the same concern for patients’ care.” 

Anthem’s announcement is the latest from insurance companies looking to limit reimbursement for anesthesia providers. Both Anthem and Cigna have also recently announced that CRNAs will receive 15% less than other anesthesia providers for delivering the same anesthesia services. 

In 2010, the provider nondiscrimination provision in the Affordable Care Act (ACA) was passed to prohibit health plans/health insurance companies (commercial payors) from discriminating against providers on the basis of licensure, including setting up different reimbursement policies for those providers delivering the same high-quality healthcare services. In 2020, the No Surprises Act required the Department of Health and Human Services (HHS), the Department of Labor, and the Department of Treasury to issue rules and enforcement policies within one year. However, there is still no level of enforcement in place. Until this is completed, commercial payors like Anthem can jeopardize patients’ access to care through discriminatory policies. 

AANA filed a petition for a writ of mandamus in the United States District Court for the Northern District of Ohio asking the court to compel HHS Secretary Xavier Becerra to perform a duty he is legally obligated to perform — enforce the provider non-discrimination provision of the ACA against insurance companies and health plans. 

“While we appreciate Anthem doing the right thing, we call on Anthem and other commercial payors to reverse course on these other discriminatory policies immediately. We also call on HHS to enforce the provider nondiscrimination provision of the ACA. Enforcement is crucial to protect patients’ access to care and help lower healthcare costs,” said Setnor. 

CRNAs administer more than 58 million anesthetics and pain management services each year to patients in the U.S. They are involved in every aspect of anesthesia in all types of settings — especially in rural areas.  

As Advanced Practice Registered Nurses and members of America’s most trusted profession according to Gallup, CRNAs practice with a high degree of autonomy and are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure, and certification.