Ms. Gail Boudreaux
President and Chief Executive Officer
Elevance Health
220 Virginia Avenue
Indianapolis, IN 46204
Dear Ms. Boudreaux,
On behalf of the undersigned physician organizations, we write to express our concerns about your recently announced Facility Administrative Policy: Use of a Nonparticipating Care Provider and to urge you to immediately rescind this policy.
It is our understanding that under this new policy, being rolled out in 11 states starting January 1, 2026, Anthem Blue Cross and Blue Shield plans will begin penalizing hospitals with a 10 percent reimbursement cut when out-of-network physicians are used in the provision of care. Moreover, your announcement indicates that you will also consider terminating hospitals from Anthem networks for continued use of nonparticipating physicians.
First, we are dismayed that Anthem is attempting to bypass the negotiated bipartisan policy under the No Surprises Act (NSA) that protects patients from surprise medical bills when out-of-network care is provided at an in-network hospital. On average, a physician practice has 20.2 health plan contracts, and even small practices with under five physicians average 13.5 health plan contracts.1 To expect that a hospital and practice will align perfectly in terms of their health plan contracts is simply unrealistic. After years of experimentation in the states, negotiations between policymakers, and compromises by all stakeholders to address this inevitable lack of alignment, the NSA was enacted with broad bipartisan support. The NSA established a system by which patients do not pay more than in-network rates for out-of-network care at participating hospitals, and health plans and physicians engage in negotiations and potentially an independent dispute resolution process to determine a fair payment amount. Though many surprise billing proposals were debated during the NSA negotiations, Congress landed on a policy that did not compel or push physicians into all health insurance networks but rather focused on patient protections and fair payment. We find it very concerning that rather than working through the NSA, Anthem is choosing to implement a policy that essentially circumvents the statute.
Read the full letter here.
