Eliott Dear: Anesthesiology Underpayment — The Specialty That Got Crushed

Since January 2022, one specialty in particular has absorbed a sharp drop in median commercial OON reimbursement, most of it within eighteen months.

The specialty is anesthesiology. Eliott Dear has spent the last two years working with anesthesia groups across multiple states to map the underpayment and build state IDR submissions.

Why Anesthesia Got Hit Hardest

Three structural features made anesthesia the worst-case specialty. First, anesthesia is almost always provided in a facility setting where the patient cannot choose the provider. Second, carrier in-network rate datasets have historically under-counted anesthesia base units and time units. Third, the largest anesthesia groups are private-equity-owned, which means the carriers had aggressive negotiation leverage even before 2022 — and the carriers have used the years since to push contract terms even lower.

The combined effect: carrier allowed amounts on common anesthesia CPT codes (00100, 00400, 00810, 00840, 01400, 01992) frequently land far below the FAIR Health 80th-percentile UCR for the same code and geo-zip.

The Base-Unit / Time-Unit Twist

Anesthesia billing is unlike other specialties. The CPT code identifies a procedure-class base unit; time is added in 15-minute increments at a per-unit rate. The unit rate is the variable carriers contest. Carriers anchor the unit rate to their own internal in-network medians, which average around $25-35 per unit in many markets. FAIR Health 80th-percentile data for the same markets supports unit rates of $80-130 in many geo-zips.

That gap, multiplied across tens of thousands of cases per group per year, is the underpayment volume Eliott Dear sees in anesthesia intake.

The State IDR Path

Fully-insured commercial policies in states with their own IDR systems (NY, TX, NJ, CT, GA, NM among others) go to state IDR. The state IDR statutes look to FAIR Health UCR data and state-specific reasonableness factors.

Eliott Dear and Claims Assassins file state IDR for anesthesia groups the same way they file for ER physicians and plastic surgeons. Each submission is attorney-signed. The FAIR Health geographic 80th-percentile data is pulled and cited per CPT. The carrier’s historical payment pattern is reconstructed from prior remits.

What Anesthesia Groups Should Do Now

Pull a representative sample of 2025-2026 commercial OON anesthesia EOBs. Compare the allowed rate per base unit and per time unit against the FAIR Health 80th-percentile UCR for each geographic locality. If the gap is material, the next step is the eligibility triage: which of those claims are fully-insured commercial policies in a state-IDR state (state-IDR eligible), which are not, and which are Medicaid Managed Care (no IDR path, appeal track).

That triage is the first hour of any Claims Assassins anesthesia engagement.