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A lawmaker wants to keep health insurers and employers' group health plans from putting limits on how long coverage for anesthesia can last.
Rep. Ritchie Torres, D-N.Y., has introduced a new version of the "Anesthesia for All Act."
The bill, which is similar to a bill that Torres introduced in 2024, in an earlier session of Congress, would prohibit plans from imposing "arbitrary time caps on anesthesia services" during an operation or other procedure, according to the bill text.
The anesthesiologist or other professional providing the anesthesia would have to be in charge of determining the duration of the anesthesia services.
The backdrop: Doctors and hospitals have been trying to increase revenue by using systems that help them document care more thoroughly and by billing for care using strategies that maximize the claimed amount. A new billing system might bill for a heart operation as one procedure, if that maximizes the total, or bill for some or all of the services provided separately, if that maximizes the total.
Companies like Aetna and UnitedHealthcare have been resisting what they see as aggressive "upcoding" by "editing" the claims, or trying to compensate for the effects of the upcoding. In some cases, the insurers have used artificial intelligence systems or other automated systems to apply the claim edits automatically.
In 2024, Anthem Blue Cross Blue Shield, a unit of Elevance, announced, but later canceled, plans to impose time limits on anesthesia coverage in Connecticut, Missouri and New York.
The providers have argued that their billing strategies help them fight efforts by giant health insurers to short their pay.
Health insurers, and administrators of employers' self-insured health plans, argue that they have to do what they can to keep a recent surge in claims from pushing employers to narrow or drop health benefits.
One new wrinkle is that the current secretary of Labor, Lori Chavez-DeRemer — one of the federal regulators who might be involved in implementing any new federal anesthesia mandates — is the wife of an anesthesiologist.
What it means: Members of Congress are watching news about health insurer and health plan claim denials closely. In some cases, they may understand the patients' and providers' frustration better than they understand the cost pressure facing the insurers and plans.
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