Payer consolidation has accelerated to a pace that most ASC administrators did not build into their contracting assumptions.
Cigna sold its Medicare Advantage business to Health Care Service Corp. in 2025. Smaller Blues plans are affiliating with larger ones. Health system-owned plans are shutting down. Each transaction reshuffles the network relationships, fee schedules and credentialing agreements ASCs depend on to keep their OR schedules full.
The operational disruption from payer mergers compounds over time. When two health plans merge, integration typically unfolds over three years, with a planning year, a building year and a full technology migration year, EY-Parthenon principal Deblina Ghosh told Becker’s. During that window, claims payment systems, provider directories, credentialing databases and network rosters are all in a state of transition.
“The breakdown is rarely the platform,” she said. “It is really the data quality that’s coming. It’s the workflow redesign and the operational readiness.”
For ASCs, that breakdown could show up as delayed claims, credentialing gaps and network reclassifications that can take months to identify and resolve.
ASCs are no stranger to payer issues. Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif., told Becker’s that broken payer contracts have been pushing her ASC to the breaking point.
“The payers simply will not negotiate,” she said.
In the last 30 days, Ms. Cunningham said she received a message from a commercial payer announcing it was not opening contract negotiations with any ASCs.
“They said they value us but cannot afford to pay us more, and that any open discussions were being closed out,” she said.
In the era of payer “surgical portfolio moves,” large national payers are reallocating capital and sharpening focus, resulting in divestitures and buying assets for specific capabilities rather than simply adding members, according to Ms. Ghosh. That focus means the acquiring payer may have a different network philosophy than the plan it absorbed, and ASCs that were preferred providers under the old plan may find themselves renegotiating from scratch.
A parallel contracting disruption is already documented and escalating. More than 23 health systems have dropped Medicare Advantage plans in 2026, including Minneapolis-based Fairview Health Services going out of network with UnitedHealthcare MA effective Jan. 1, 2027; Providence, R.I.-based Brown University Health physicians going out of network with UnitedHealthcare MA on July 1; Greenville, N.C.-based ECU Health going out of network in phases; Radnor, Pa.-based Main Line Health going out of network July 1; and New York City-based NewYork-Presbyterian and UnitedHealthcare MA set to go out of network on July 31 without a new agreement in place.
For ASCs affiliated with or owned by health systems that drop MA plans, the downstream effect could mean patients who previously had in-network access to the ASC through the health system’s MA relationship will face higher cost-sharing or no coverage at all.
The practical implication is a contracting calendar problem. Most ASC provider agreements renew annually or on a multiyear cycle, and payer mergers do not announce themselves on a timeline that aligns with contract renewal windows. In the current payer M&A environment, regulatory considerations are being built into deal structures from the start rather than treated as an afterthought, according to Ms. Ghosh. Consultants are encouraging clients to build regulatory cases accounting for several “what-if” scenarios alongside financial and strategic cases.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
