“ Updated 3 hours ago - Business Anthem Blue Cross Blue Shield calls off surgery anesthesia cap major health insurance company is backing off of a controversial plan to limit coverage of anesthesia, according to public officials. Why it matters: Anthem Blue Cross Blue Shield recently decided to "no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes," according to the American Society of Anesthesiologists, which opposed the decision. The decision covered plans in Connecticut, New York and Missouri. The insurer had based the move on surgery time metrics from the Centers for Medicare and Medicaid Services, NPR reported. Friction point: The decision was controversial at the time — but outrage erupted this week after the murder of UnitedHealthcare CEO Brian Thompsonin New York City cast a spotlight on divisive insurance decisions. The latest: "After hearing from people across the state about this concerning policy, my office reached out to Anthem, and I'm pleased to share this policy will no longer be going into effect here in Connecticut," Connecticut Comptroller Sean Scanlon said Thursday on X. "We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy," New York Gov. Kathy Hochul said Thursday in a statement. "Don't mess with the health and well-being of New Yorkers — not on my watch." Anthem representatives did not immediately respond to requests for comment. The initial coverage decision was very unusual for a major health insurer, said Marianne Udow-Phillips, who teaches insurance classes at the University of Michigan School of Public Health and formerly made coverage decisions at Blue Cross Blue Shield of Michigan. "When patients become financially responsible because a health plan cuts how much they pay providers, that's what breeds all this anger," Udow-Phillips tells Axios. "This is a colorful and terrible example of administrative excess in the insurance industry, but boy, I tell you, it's just the tip of the iceberg," Gordon Morewood, an anesthesiologist and vice chair of ASA's Committee on Economics, tells Axios' Maya Goldman. On social media, critics drew a direct line from controversial coverage decisions to the death of Thompson https://www.axios.com/2024/12/05/blue-cross-blue-shield-anesthesia-anthem-connecticut-new-york
The NYPD say the weapon is a B&T Station Six. lol it’s not. It’s a SA. He was seen racking the slide bc used a PCC suppressor. They don’t have boosters. I am sure they are checking the NFA registry for the wrong firearm, Utterly inept.
If you don't condone violence then you will realize it's senseless. Regardless what UNH did or Brian did or did not do, going up to somebody and killing him in cold-blood does not make sense and is not right, hence the word "senseless"; it makes no sense. We have a court of law and we are governed by rule of law. If you have a problem with someone, you bring him to a court of law and duke it with him there, not going up to him and killing him. Using your words, I don't condone the unscrupulous things that private health insurance companies have done to their policyholders in America but killing a CEO of an insurance company does not solve anything.
I said IF he's smart. But then again he might not want to be "smart", he might want to be known and/or send a statement, hence the engraved bullets which he knew would be found.
Right-e-O “ Medicare Advantage insurers for using predictive technology to deny claims UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report for a Senate subcommittee. Published Oct. 21, 2024 By Susanna VogelStaff Reporter Insurers used technology to increase denials services in skilled nursing homes between 2019 and 2022. Adene Sanchez via Getty Images Dive Brief: A new Senate report sharply criticizes the country’s three largest Medicare Advantage insurers — UnitedHealthcare, Humana and CVS — for allegedly limiting access to post-acute care to maximize profits. The insurers leveraged algorithmic tools to sharply increase claims denials for MA beneficiaries between 2019 and 2022, according to the report published Thursday by the Senate Permanent Subcommittee on Investigations. They most often denied coverage to patients in nursing homes, inpatient rehab hospitals and long-term hospitals, the report found. MA payers have previously come under fire from lawmakers for using algorithms to determine coverage. UnitedHealth and Humana have also been sued for denying MA beneficiaries care using the technology. Dive Insight: Prior authorization requires providers to submit paperwork to insurers certifying that treatments are medically necessary prior to performing them. Insurers argue that prior authorization curbs unnecessary treatments, saving the healthcare system valuable dollars. Meanwhile, providers and other critics argue it’s burdensome — and used by insurers to avoid paying for medical care. In recent years, insurers have increased their denials of prior authorization requests, particularly for patients covered by Medicare Advantage. The 54-page Senate report argues this uptick in denials is intentional. “Medicare Advantage insurers are intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities,” the report says. Between 2019 and 2022, UnitedHealthcare, Humana and CVS each denied prior authorization requests for post-acute care “at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for Medicare Advantage beneficiaries,” according to the report. In those four years, UnitedHealth’s post-acute services denial rate increased from 8.7% to 22.7%, the report found. Meanwhile, UnitedHealth’s skilled nursing home denial rate increased ninefold. These increases coincide with UnitedHealth’s use of NaviHealth-backed nH Predict, an algorithmic tool used to manage claims denials, the Investigations subcommittee alleges. The tool is at the center of a lawsuit filed in November 2023, which alleges UnitedHealth inappropriately relied on the algorithm to adjudicate MA claims despite knowing nH Predict was riddled with errors. UnitedHealth denies the lawsuit has merit. CVS similarly rolled out a “Post-Acute Analytics” project in 2021, which harnessed AI to reduce money spent on skilled nursing facilities, according to the report. In terms of savings, the initiative was a wild success. CVS initially expected the algorithm would save the company $10 million to $15 million in the first three years. However, several months later, CVS projected $77.3 million in savings during that same time period, the Investigations subcommittee found. Similarly, Humana’s denial rate for long-term acute-care hospitals increased 54% between 2020 and 2022 following training sessions about evaluating prior authorization requests for post-acute services. The sessions allegedly included tips on how to justify denials when speaking to providers. Research has shown patients who appeal preauthorization denials are likely to win. As of 2022, over 80% of appealed MA prior authorization denials were decided in patients’ favor. However, few beneficiaries actually appeal coverage denials, according to provider and patient advocacy groups. In light of the findings, the Senate subcommittee recommended the CMS conduct targeted audits of insurers’ prior authorization data. It also asked regulators to consider expanding regulations governing the issue of predictive technologies to ensure workers aren’t bound by the tools’ recommendations when making final claims decisions. Lawmakers have signaled interest in overseeing payers’ use of AI. Last spring, the Senate subcommittee held a hearing on AI’s role in increased denials. “I want to put these companies on notice. If you deny lifesaving coverage to seniors, we’re watching, we will expose you, we will demand better, we will pass legislation if necessary, but action will be forthcoming,” Sen. Richard Blumenthal, D-Conn., chair of the Permanent Subcommittee on Investigations, said at the time.
Yeah, I use to spend time helping church elderly fight these companies, appeal after appeal because of their blanket denials. They kick old people out of skilled nursing after a week even though they had months of coverage for that. There are courts for the poor and destitute to fight these crooks?
Well, it looks like Anthem decided to reverse their ridiculous new policy. So it solved that problem. Apparently their CEO decided he didn't want to get shot and killed by a patient who was denied anesthesia during surgery.
If surgery lasted longer than Anthem deems fit, they deny payment on anesthesia excluding pregnancy or those under 22 years old. Anthem said everyone is misquoting their new policy.