In a controversial policy change, BlueCross BlueShield (BCBS) no longer reimburses anesthesiologists for physical status modifiers that classify the complexity of patients. The new policy went into effect in August 2024 for BCBS plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.
Complex patients typically have multiple or severe health conditions; they may require advanced anesthesia techniques from subspecialty-trained anesthesiologists during a procedure. According to BCBS, the new policy streamlines costs and improves overall efficiency, but critics argue that the move jeopardizes patient safety, limiting access to experts.
“BlueCross BlueShield is a huge payer in Illinois. They cover almost 9 million lives,” says Marco Fernandez, MD, president of the Association for Independent Medicine and Midwest Anesthesia Partners.
The healthcare community argues that while cost efficiency is important, it should not come at the expense of patient safety and quality of care.
In a letter to the Illinois Society of Anesthesiologists, President Jason Mitchell, MD, outlines efforts to challenge this new policy. He and other physician leaders met with BCBS to urge them to reconsider.
The decision, Mitchell wrote in the letter, “will also reduce access to anesthesia services as practices may no longer be able to provide services at their current levels.”
Fernandez agrees. “The majority of us can’t sustain ourselves.
We get subsidies from hospitals, [but] this will make things worse.”
Despite the outcry, the policy remains in effect, raising concerns about the future availability and quality of anesthesia care for complex patients in Illinois.
Originally published in the Fall 2024/Winter 2025 print issue.
Catherine Gianaro, a freelance writer and editor based in Chicago, has written about healthcare and higher education for more than three decades. With 90-plus awards in communications, she is well-versed in storytelling.
