Elevance Health (formerly known as Anthem) recently shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans. This policy is scheduled to take effect on January 1, 2026.
The policy would possibly assess facilities "an administrative penalty equal to 10 percent of the allowed amount of the facility's claims that involve the use of nonparticipating care providers." Providers cannot have members cover this penalty. Providers could also be terminated from Anthem’s network under the new policy.
While Anthem has outlined exceptions for emergency services and when the insurer issues prior authorization, APMA has significant concerns as to how this policy will impact our members. APMA will investigate further and decide on the best course of action. We will provide our members with updates in future communications.
Contact the APMA Advocacy Department with any questions or concerns.