Insurance company changes anesthesia coverage: Who it impacts

Medical Mutual has changed its reimbursement policy regarding anesthesia coverage just weeks after United Healthcare CEO Brian Thompson was killed on the streets of Manhattan.

The new reimbursement rules, which go into effect January 24, slash the insurer’s certified registered nurse anesthetist reimbursement by 15 percent.

Why It Matters

The decision by Medical Mutual mirrors other insurers like Anthem Blue Cross Blue Shield who have made similar cuts to keep costs down.

Medical Mutual insures more than 1.6 million Americans, many of which live in rural communities in Ohio, where the company is based.

While Americans have long been critical of insurers’ high prices for customers and coverage approval decisions, Thompson’s murder put insurers’ role in the healthcare industry back into the spotlight.

Patients are expressing increasing frustration with the larger healthcare system in America, and Medical Mutual’s anesthesia rule could mean millions of Americans see far higher medical bills in 2025.

What To Know

Medical Mutual adopted a new reimbursement policy for anesthesia services that goes into effect January 24.

The new policy slashed Certified Registered Nurse Anesthetist (CRNA) reimbursement by 15 percent.

The coverage is based on the minutes of anesthesia required with one unit applied for each 15-minute interval.

Newsweek reached out to Medical Mutual for comment via email.

Anthem Blue Cross Blue Shield made a similar decision to cut anesthesia coverage for gastroenterology patients but reversed the decision in December, shortly after Thompson’s death.

The Kaiser Foundation Health Plan also made a similar decision to keep anesthesia reimbursement rates in Washington state amid the backlash.

What People Are Saying

Jan Setnor, President of American Association of Nurse Anesthesiology (AANA), told Newsweek: “CRNAs are often the only anesthesia providers in the rural communities across the nation, including rural communities in Ohio where Medical Mutual is headquartered. These attempts by insurers to restrict CRNAs’ practice underscores the critical need for HHS to enforce the nondiscrimination provision and is why AANA continues its litigation in the United States District Court for the Northern District of Ohio to compel HHS to enforce the law.”

Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek: “Medical Mutual’s decision just puts more pressure on already strained rural health providers. In many rural areas, a certified registered nurse anesthetist is the only option for patients and subsequently the one they’re going to use insurance to help cover. Cutting back that reimbursement rate by 15 percent causes further financial strain on the patient and the provider. Insurance providers may say these measures are necessary for cost-control reasons, but if this ends up being more expensive for those they cover, it’s not going to be a winning proposition for all sides.”

Smile Insurance Group CEO Chris Fong told Newsweek: “This would primarily affect CRNA medical professionals. The patients could become affected if there are fewer and fewer CRNAs especially in rural areas. This could result in delays in surgeries and lack of epidurals for births due to potential staffing shortages.”

What Happens Next

Setnor said the Medical Mutual decision underscores continuing frustrations Americans are feeling as they’re forced to take massive financial obligations even in the case of life-saving or medically necessary procedures.

“In an ideal world, health insurers would assist their customers with health care costs rather than inflate their profits and hinder those customers from getting the care they so desperately need,” Setnor said. “This policy announcement is a blatant, dangerous, and self-serving attack on CRNAs and the patients they seek to care for.”