WA lawmakers look to prohibit time caps on anesthesia reimbursement

OLYMPIA — Washington lawmakers are reintroducing a bill that would protect insurance coverage on anesthesia services. 

House Bill 1812, sponsored by Rep. Alicia Rule, D-Blaine, would prohibit health carriers from denying coverage or capping reimbursement based on the duration of anesthesia used during a procedure. The bill applies to health carriers offering health plans to public employees, including Medicaid and plans administered by the Washington Health Care Authority. 

“Anesthesia, as you can imagine, is not optional, it's necessary,” Rule said in a public hearing Tuesday. “This bill also protects patients from surprise bills, support access to surgical care when people need it, and leaves the decision-making right where it belongs with the trained professionals who are meant to do this work.” 

The legislation outlines enforcement policies by the Office of the Insurance Commissioner including monetary penalties, requiring health carriers to reimburse for improperly denied claims, and the suspension or revocation of health carrier’s licenses for repeated or egregious violations. 

Rule is taking proactive measures after health insurer Anthem Blue Cross Blue Shield, attempted to establish a time cap on anesthesia used in procedures in late 2024. The proposed policy was ultimately rolled back after significant public backlash, prompting many states to take action to prevent similar policies from happening in the future. 

If enacted, the bill would maintain the current Center for Medicare and Medicaid guidelines for anesthesia reimbursement, which are calculated using 15-minute increments, with additional payments added to account for complexities during a procedure. 

Kelli Camp, president of the Washington Association of Nurse Anesthesiology, testified in support of the bill, asserting it is necessary to protect both patients and medical professionals from unexpected financial burdens when surgeries exceed their anticipated duration. 

“Anesthesia care is not a flat or predictable service,” Camp said.

Anesthesia reimbursement is highly individualized based on the time needed to administer care before, during, and after a procedure according to 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. 

Camp explained that placing artificial time caps on reimbursement would undermine long-standing precedent that ignores the clinical complexity medical providers face. 

Dee Bender, vice president of the WANA, echoed similar sentiment, adding that the time caps could pressure providers to rush care while forcing hospitals to absorb additional costs.  

“These time limits also put an immense strain on hospitals that train the next generation of surgeons,” she said. “That means when something goes wrong, the insurance company is allowed to just say, this is on you.” 

Camp explained that anesthesia reimbursement is especially crucial for rural facilities where access to a variety of health resources is limited. Additional costs could threaten the financial stability of many rural hospitals who already operate on thin margins. 

“Insurance companies should not be practicing medicine,” Rule said. “Surgeries don't follow a timer.”

The legislation was originally introduced during the 2025 legislative session but did not receive a public hearing. This year, it was heard Tuesday, Jan. 27, at the House Healthcare and Wellness Committee with an executive session yet to be scheduled.