A broad coalition of physician organizations, including ASGE, is urging Elevance Health to withdraw its new “Facility Administrative Policy: Use of a Nonparticipating Care Provider,” set to take effect in 11 states on January 1, 2026.
The policy would cut hospital reimbursement by 10% when out-of-network physicians provide care and could remove hospitals from Anthem networks for continued use of nonparticipating providers. Physician groups argue this undermines the No Surprises Act (NSA), which protects patients from unexpected medical bills and supports fair payment negotiations.
In their letter to CEO Gail Boudreaux, the organizations warn the policy will financially strain independent physician practices, push more physicians into hospital employment, and reduce patient access—especially in rural communities. They also question whether the policy erodes the value of policies purchased by Anthem members that allow them to access out-of-network providers.
The letter encouraged Elevance to focus on solutions that promote network participation, such as fair contracting, lower administrative burdens, and streamlined payment processes.