Health insurer Anthem has announced a new policy that will penalize hospitals for using doctors who aren't part of its network, a move that critics warn could shrink patient options and disrupt care. Under the policy, set to debut on Jan. 1, hospitals in 11 states—including Colorado, Georgia, and New Hampshire—will see their reimbursements cut by 10% if they use out-of-network providers, per the Lever. Hospitals may also risk being dropped from Anthem's network altogether. Anthem, which is managed by Elevance Health and operates Blue Cross and Blue Shield plans in 14 states, says the policy is meant to lower members' out-of-pocket costs and shield them from unexpected medical bills.
A spokesperson for Elevance Health said the policy will support fair contracting and prevent abuse, ultimately benefiting patients. But medical groups argue the change will force hospitals to track which doctors are in-network, a task they say is impractical and raises legal and ethical questions. In a recent letter to Elevance Health leadership, three medical societies warned that hospitals might feel compelled to reorganize or swap out physician groups, potentially disrupting care and creating gaps in critical services like anesthesia.
"Surgeries are delayed and even canceled until the new group can fully staff up," says Patrick Giam, president of the American Society of Anesthesiologists. Critics also argue that the policy undermines the spirit of the federal No Surprises Act, which was designed to protect patients from unexpected bills and require insurers and providers to negotiate costs in good faith. Wendell Potter, a health insurance reform advocate, said the policy will instead force hospitals to keep certain doctors away from Anthem patients or risk losing their network status.
Anthem's move follows similar actions by other major insurers, including UnitedHealthcare and Cigna, which have both faced backlash for slashing payments to providers or dropping doctors from their networks. Anthem says the policy is a response to providers using the No Surprises Act's dispute resolution process to seek higher payments for planned procedures, which the insurer claims drives up costs for everyone. MedPage Today uses the example of spinal fusion surgery, a procedure that Medicare usually pays about $1,000 to $2,000 for. If a procedure by an out-of-network doctor goes to arbitration, however, the average award is closer to $80,000.
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