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Anthem BC/BS of California to Reconsider Anesthesia for Cataract Coverage Policy Following ASCRS and Ophthalmic Community Advocacy

Recently, Anthem Blue Cross/Blue Shield of California announced it would no longer be covering anything but topical, local, or regional anesthesia for cataract surgery, as it had determined that deeper levels of anesthesia is not medically necessary. Anthem would only cover anesthesia services, such as moderate sedation or general anesthesia, in limited cases, such as pediatric cases or if the patient cannot cooperate or communicate. In response, ASCRS sent a letter to Anthem requesting the coverage policy be rescinded since most ophthalmologists use intravenous anesthesia or sedation for cataract surgery as an addition to local or topical anesthesia. The letter notes that patients undergoing cataract surgery are generally elderly with co-morbidities and significant medical issues, which require the patient to be sedated. In addition, it may not be possible to predict the level of sedation a particular patient needs pre-operatively. Upon receiving ASCRS’ letter, and others from the California Academy of Ophthalmology and AAO, Anthem indicated that it would be reviewing its coverage decision further. We will keep you updated. 

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