New Anthem Policy Penalizing Hospitals Set to Disrupt Patient Care

FOR IMMEDIATE RELEASE
January 13, 2026

CONTACT 
Christopher Sheeron
+1 (202) 823-2333
media@action4health.org

WASHINGTON — As of January 1, Elevance Health, the parent company of Anthem Blue Cross and Blue Shield, has implemented a new policy in 11 states (CO, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI) that penalizes hospitals when patients receive care involving out-of-network physicians.

Under the policy, Anthem plans assess a 10% administrative penalty on hospital facility claims whenever a nonparticipating physician is involved in a patient’s care. Elevance has also indicated hospitals could be removed from its network for continued use of out-of-network physicians.

Why It Matters for Patients and Caregivers

Healthcare leaders, including the American Medical Association, warn the policy could delay care, limit access to specialists, and create confusion for patients and families, particularly during emergencies or complex hospital stays when patients have no control over which clinicians treat them. Hospitals, especially in rural and underserved communities, often rely on a mix of participating and nonparticipating specialists to maintain around-the-clock coverage.

Concerns From Physicians and Hospitals

The Federation of American Hospitals states that the policy undermines the bipartisan No Surprises Act, which already protects patients from surprise medical bills and established a legal process for resolving out-of-network payment disputes. Elevance’s approach shifts financial pressure onto hospitals and physicians rather than addressing insurer network adequacy through existing law.

Hospital leaders warn they are unlikely to absorb the 10% cut, potentially forcing difficult decisions that could affect staffing, specialty coverage, and patient access. Physician groups caution the policy may accelerate consolidation, push independent practices out of the market, and reduce patient choice over time.

Outside experts have also raised concerns about the insurer’s motives.

“It’s clear to me that the company is using what it claims is physician manipulation of the No Surprises Act as an excuse to pad its bottom line and boost earnings per share for investors by eliminating patient choice and putting patient care — and the financial solvency of hospitals and physician practices — at risk,” said Wendell Potter, president of the Center for Health and Democracy and a former vice president at Cigna Healthcare.

Advocates warn the policy could spread beyond these states if left unchecked.

“If insurers are allowed to penalize hospitals for care decisions patients cannot control, we should expect more policies like this to follow,” said Christopher Sheeron, president of Action for Health. “The real risk is that patients and caregivers across the country will pay the price through delayed care, fewer specialists, and weaker local health systems.”

Bottom Line

While Elevance has framed this policy as patient-protective, medical organizations say it could have the opposite effect — disrupting care, increasing administrative delays, and placing patients and caregivers in the middle of insurer-provider disputes, with broader implications if the approach expands beyond these initial states.