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Perspective
October 14, 2013

Mandatory Anesthesia

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2013;173(18):1671. doi:10.1001/jamainternmed.2013.9164

My brother recently had an outpatient cataract extraction. Although he is a fit, healthy, 53-year-old man, who regularly bench presses more than his body weight, rides his bike up the mountain, and has no medical problems (other than vision), he was told he must have a history, physical examination, and electrocardiogram before the procedure. Because he has a health plan with a high deductible and copayment, a physician visit is expensive for him. After getting “clearance” for this procedure, he proceeded to schedule it. Being a diligent professional, he wished to return to work after the procedure and informed his physician that he did not desire anesthesia for the cataract extraction. On the morning of his procedure, he was told that even though he declined anesthesia (and oral sedative), he had to have an intravenous line placed, “just in case.” The procedure was uneventful, without anesthesia, and he returned to work. However, he had a rude shock when he received the bill for the procedure, which included $408 for administration of anesthesia. He first tried calling his insurance company (Cigna-Great West PPO) to inform them that they should not pay for administration of anesthesia because he did not have any. They told him to call his physician, which he did. The physician referred him to the anesthesiologist, who told him although she did not administer any anesthesia, she had to be available, just in case, and therefore insisted on billing him for “the administration of anesthesia services.”

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