Several physician associations are urging Elevance Health to abandon its new policy that penalizes hospitals and contracted facilities for using care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states.
Under the policy, finalized Oct. 1 and set to take effect Jan. 1, facilities could face an administrative penalty equal to 10% of the allowed amount of any facility claim involving a nonparticipating provider. Facilities are prohibited from passing this penalty on to patients, and they risk termination from Anthem’s network if they repeatedly use out-of-network care providers.
A joint letter from the American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology asks Anthem to withdraw the policy.
In a November news release, the groups argue it will effectively force hospitals to pressure independent physician groups into joining Anthem’s network. They warn that the need to reorganize or replace physician groups could jeopardize continuity of care and patient access to essential services.
“This policy is deeply flawed and operationally unworkable,” a joint statement said. “It effectively shifts Anthem’s network adequacy obligations onto facilities, holding them financially liable for the contracting status of independent physician groups — an area over which they have no control or infrastructure to manage.”
Additionally, according to the release, the policy could be an effort to circumvent the No Surprises Act, which created a framework to resolve payment disputes between facilities and insurers for out-of-network care.
Anthem’s policy includes exceptions for emergency services and situations in which the insurer grants prior approval.
“This new policy encourages care to be delivered by in-network providers while visiting in-network facilities, which helps provide a smoother member experience, improve affordability and reduce unnecessary administrative complexity,” a spokesperson told Becker’s. “Members will not see any disruption to their care. Out-of-network care will continue to be covered in emergency situations and when no options exist for in-network providers.”
