Anthem is now penalizing hospitals for using out-of-network providers. If you practice in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, or Wisconsin, this policy directly affects your ability to maintain hospital privileges.

Anthem Blue Cross Blue Shield finalized the policy in October 2025. As of January 1, 2026, Anthem penalizes hospitals 10% of allowed claim amounts whenever those hospitals use out-of-network providers to treat Anthem patients. These penalties can’t be passed to patients. Hospitals absorb the entire loss. Anthem also reserved the right to terminate hospital contracts for repeated violations. This means hospitals are pressuring providers to join networks or lose privileges.

What This Policy Actually Does

Anthem’s “Facility Administrative Policy on Use of a Nonparticipating Care Provider” applies to any out-of-network provider delivering care in facility settings; including inpatient, outpatient, and ambulatory surgical centers.

When a hospital lets an out-of-network specialist treat an Anthem patient, Anthem reduces the facility’s reimbursement by 10%. A $100,000 facility claim becomes a $10,000 penalty the hospital absorbs. For high-volume facilities, these penalties accumulate quickly.

There are exceptions. Emergency services stay exempt because Anthem can’t touch those without running afoul of the No Surprises Act. Anthem also waives the penalty when they’ve granted prior authorization for out-of-network care, or when no in-network provider is available.

More Than 90 Medical Associations Have Pushed Back

More than 90 specialty physician and state medical associations, including the AMA, American Society of Anesthesiologists, American College of Emergency Physicians, American College of Radiology, and dozens more, sent letters to Elevance Health demanding Anthem withdraw the policy. They called it “a blatant attempt to subvert the federal No Surprises Act” that “attempts to use hospitals as a conduit to pressure physician practices either to accept Anthem contracts” at unfavorable rates.

The letter raised a valid point. Network adequacy is the insurer’s job, not the hospitals. Anthem is supposed to build networks that serve patients. Instead, they’re punishing hospitals for gaps in Anthem’s own network, and those hospitals will pass that burden onto providers.

Despite this opposition, the policy remains in effect.

How Hospitals Are Responding

Hospital CFOs are responding predictably. They see a policy that could cost them seven figures annually, and they act.

Hospitals have three choices: (1) restrict out-of-network providers from operating rooms and inpatient units, (2) absorb penalties indefinitely while waiting for Anthem to terminate their contract, or (3) pressure out-of-network providers to join Anthem’s network.

Credentialing takes 90-120 days, a timeline that puts immediate pressure on hospitals and providers alike.

Your Arbitration Rights Are Still Intact

Anthem’s new policy doesn’t eliminate your arbitration rights. The No Surprises Act still protects your ability to file disputes on eligible claims. Federal data shows providers win 86% of these disputes, with awards running 4-5 times the insurer’s initial payment. For complex surgical cases, awards have exceeded 10 times the QPA.

But the practical reality matters. Once facilities restrict your privileges or you’ve signed a network contract under pressure, your leverage changes. The policy creates urgency to recover money you’re already owed, before hospital pressure limits your options.

Specialties Facing the Most Pressure

Anesthesia groups, especially those acquired by private equity, have maintained out-of-network status at high rates. Hospitals using these groups face immediate penalties unless contracting happens fast.

Assistant surgeons who float between hospital systems face a logistical problem. Rapid credentialing across multiple facilities takes months, not weeks.

Surgical specialists doing complex reconstructive work, including plastic surgeons, neurosurgeons, orthopedic spine surgeons, and cardiac and vascular surgeons, confront the worst calculation. Many stay out-of-network because their cases involve complexity that standard rates don’t cover.

IONM providers operate almost entirely out-of-network by design. They either contract quickly or risk losing facility access across all 11 states.

What You Should Do

If you have recent Anthem claims where arbitration deadlines haven’t passed, file now before hospital pressure forces your hand.

Talk to the hospitals where you hold privileges. Ask directly how they’re responding to Anthem’s policy. Are they restricting out-of-network access? What’s their timeline?

Get legal review to understand which claims are still eligible for arbitration. Deadlines are unforgiving and some claims may need to be filed immediately to preserve your rights.

If hospitals are demanding you join networks, have an attorney review any contract before you sign. Anthem may be offering substandard rates, expecting you to accept quickly. Know what you’re agreeing to.

Why This Policy Matters

Penalizing in-network facilities for the contracting status of independent physicians is unprecedented. Anthem isn’t directly restricting your rights under the No Surprises Act, but they are creating financial incentives that make hospitals do it for them.

Whether this end-run violates the NSA’s intent is an open legal question. The 90+ medical associations opposing the policy think it does. But waiting for courts to rule means hospitals are responding to the financial pressure now. The providers who recover the most will be those who take action while they still have options, not those who wait to see what happens.

Talk to Us

Minevich Law Group represents out-of-network providers in No Surprises Act arbitration nationwide, including federal IDR, state arbitration in New York and New Jersey, and the 11 states affected by Anthem’s new policy.

If you practice out-of-network in any affected state and Anthem has been underpaying your claims, there may be recoverable revenue. We’ll review your situation, identify what’s eligible for arbitration, and explain your options.

Call 516-202-2196 or schedule a free consultation.