Lawmakers look to ban time caps on anesthesia coverage in proposed bipartisan bill

OLYMPIA — Washington is taking proactive measures to preserve insurance coverage for anesthesia care. After facing harsh public criticism, Anthem Blue Cross Blue Shield rolled back a policy that would establish a time cap on anesthesia used in procedures. The policy was initially introduced in Connecticut, New York and Missouri before being rescinded, yet many states are taking action to prevent similar policies.  

“We will never abandon a patient and stop their anesthesia just because their time has run out,” said Kelli Camp, president of the Washington Association of Nurse Anesthesiology.  

Regence and Premera, subsidiaries or licensees of Blue Cross Blue Shield, are the most prevalent insurance providers across the state, according to bill sponsors. If enacted, HB 1812 would immediately prohibit any health care carrier from denying coverage or capping reimbursement based on the duration of anesthesia used during a procedure. The bill also outlines enforcement policies by the Office of the Insurance Commissioner including monetary penalties, revocation or suspension of operating licenses, and public disclosures of violations on the commissioner’s website.  

“I'm hoping that this bill will prevent insurance companies from thinking that this is an avenue to save money,” Rep. Michelle Caldier, R-Gig Harbor, co-sponsor of the bill, said.  

According to Courtney Wallace of Premera Blue Cross, the company generally does not restrict the use of anesthesia but emphasizes that claims should include appropriate billing codes to ensure accurate processing.  

In a statement provided to Connecticut’s FOX61, Anthem explained that the initial policy designed the time caps based on the Physicians Work Time Values from the Centers for Medicare and Medicaid Services, paying claims only up to the CMS amount. The goal was to make care more affordable by standardizing anesthesiologist pay to prevent overbilling. The statement has since been retracted.  

“When insurance companies say overbilling, I have great skepticism,” Rep. Alicia Rule, D-Blaine, the main sponsor of the bill said. “I don't believe that providers are generally quote-unquote overbilling. What they're doing is they are billing for the services they're providing, and they're providing what they need to do to administer quality care.”  

Donald E. Arnold, president of the American Society of Anesthesiologists, noted in a letter to Anthem that CMS guidelines are not intended to determine or support payment for services. He claimed the policy would alter already well-established industry standards, regulations, and billing norms.  

Payment for anesthesia is highly individualized and based on several factors including the time needed to administer care before, during, and after a procedure, said the American Society of Anesthesiologists. Unexpected complications, such as excessive bleeding, may require additional time to resolve and to ensure a safe transition into recovery, leading to higher costs.  

“If reimbursement is capped it is unclear who would bear the cost that goes above what is reimbursed,” Connie Agenbroad, Othello Hospital CEO said.  

Agenbroad explained that hospitals may have to absorb the additional expenses, possibly reducing services in order for facilities to stay fiscally stable. She highlighted how detrimental the caps can be in rural areas, where having access to a variety of health resources is imperative.  

Camp adds that any cost hospitals or providers absorb is ultimately passed on to the patient, subjecting many to pay out-of-pocket bills that can range from hundreds to thousands of dollars.  

She also shared one of patients' biggest fears is waking up or experiencing awareness during a procedure. Any policy suggesting anesthesia could wear off prematurely would heighten this fear, causing even greater distress.   

“Patients do not need to worry that anyone is rushing or cutting corners to attempt to stay within an arbitrarily set time,” urged Agenbroad.  

Despite Anthem’s policy rollback, the health care industry remains under close scrutiny by the public, with many believing the system is largely driven by giant corporations and insurance companies.  

“Insurance companies are very creative and their whole job is to make a profit,” Caldier said.  

She further explained insurers have flexibility in how they execute their contracts, sometimes requiring rules for pre-authorization that often deny coverage even when there is no way to predict what exact services are necessary.  

Former Washington Sen. Kevin Van De Wege, a Democrat who is lobbying in support of the bill, argues it would not harm insurance companies. However, it would hold them accountable for prioritizing profits over patient care.  

Washington is now the seventh state to propose similar legislation with a federal bill titled the Anesthesia for All Act introduced in Congress in December 2024.  

Although a public hearing has yet to be determined, sponsors emphasized the legislation has gained traction on both sides of the aisle. 

“All of the major parties are in support of this bill,” said Rule. “That doesn't happen very often.” 

    State Rep. Alicia Rule, D-Blaine, is the prime sponsor of a bill to prevent insurers from capping how long they will pay for patients to be under anesthesia. The measure has significant bipartisan support in Olympia so far.