On August 29, 2025, Independence Blue Cross (IBX) announced a policy change that cuts reimbursement by 15% for anesthesia services provided CRNAs when practicing independently (services appended with the QZ modifier). IBX’s anesthesia reimbursement change is effective December 1, 2025, applies to both Commercial and Medicare Advantage plans, and will affect providers in Philadelphia and southeastern Pennsylvania. This discriminatory policy directly violates the Provider Nondiscrimination provision of the Affordable Care Act (ACA), which prohibits insurers from reimbursing providers differently based solely on licensure. Although the No Surprises Act of 2020 required the Department of Health and Humans Services, the Department of Labor, and the Department of Treasury to issue regulations within a year, no such rules have been implemented, allowing insurers like IBX to continue discriminatory practices that threaten patient access to care. In response, AANA is finalizing a formal cease-and-desist letter to IBX and is coordinating with the Pennsylvania Association of Nurse Anesthetists associations to mobilize their state hospitals, ambulatory surgical centers, rural health stakeholders, and insurance commissioners to demand a reversal. The Federal Government Affairs team is also engaging with federal agencies and the administration to escalate pressure and ensure compliance with existing federal law.
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