Local eye doctors say Anthem’s new policy is ‘very dangerous’

Anthem notified ophthalmologists that it won't pay for anesthesia specialists for healthy adults having eye surgery

Doctors say a new money-saving measure by a large insurance company will put patients at risk.

YOUNGSTOWN, Ohio (WKBN) – Doctors say a new money-saving measure by a large insurance company will put patients at risk.

Anthem Blue Cross and Blue Shield notified ophthalmologists that it would no longer pay for anesthesia specialists for healthy adults having eye surgery.

That means patients can choose to skip anesthesia during surgery or pay for the bill out of pocket.

As one Beaver Township doctor was told, the doctor is expected to do surgery and handle anesthesia at the same time.

“What they are pushing us to do is to do two things at the same time. I’ve got my brain and my hands full enough just doing the surgery. I don’t have time, nor do I have the skill. It’s not my area of expertise,” said Dr. John Aey, of Eye Care Associates.

Dr. Aey said the policy change is only for adults under the age of 65, but it could be expanded to cover Medicare patients at some time in the future.

“It’s very dangerous,” he said. “The number of people who can sit still with instruments inside their eye is almost zero.”

Anthem sent an email about the policy saying anesthesia is covered when “medically necessary” and that its new policy was reviewed by outside doctors

Anthem is committed to providing consumers with access to high quality, affordable healthcare, including safe and effective medical technologies. One of the ways we work to meet this commitment is to ensure consumers receive the right care, at the right time, in the most appropriate clinical setting.

In line with this commitment Anthem’s Medical Policy & Technology Assessment Committee, a majority of whom are external physicians, reviewed the available evidence addressing the use of general anesthesia and monitored anesthesia care for cataract surgery. According to the literature reviewed, there is no one definitive approach regarding the use of anesthesia for cataract surgery and patient specific needs should be taken into consideration as well as potential risk of harm to individuals who are sedated during surgical procedures. Anthem’s guideline allows for general anesthesia and monitored anesthesia care for cataract surgery when clinical indications support that they are medically necessary and provides coverage for other forms of anesthesia without the need for review.

We value our relationships with providers. We have been and will continue to have a dialog with our providers and medical societies regarding their concerns.”

This comes after Anthem decided to make a significant change to its emergency room program.

The insurance company will no longer pay for emergency room visits if the patient’s condition is deemed a non-emergency.


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