APMA Expresses Opposition to New Elevance Proposal on Out-of-Network Provider Use

Last week, APMA expressed its significant concerns and opposition to Elevance over Anthem Blue Cross Blue Shield's (Anthem) recently announced Facility Administrative Policy: Use of a Nonparticipating Care Provider. Under this new policy, effective in 11 states on January 1, 2026, Anthem plans will penalize hospitals with a 10 percent reimbursement reduction when out-of-network physicians are used in the provision of care at in-network hospitals. Additionally, the new policy also states that Anthem will also consider terminating hospitals from Anthem networks for continued use of nonparticipating physicians.

Aside from the implications that Anthem is seeking to circumvent the intentions and requirements of the No Surprises Act, APMA also believes that this policy will create significant negative consequences. Providers and hospitals may be forced to accept contracts that they would not have accepted otherwise, and patients may experience significant delays in access to care.

APMA urged Elevance to rescind this policy and instead offer more compelling alternative terms that would make it more likely for physicians to join or remain in Anthem's networks. This would result in greater provider-hospital plan contract alignment.

To read this letter and other comment letters in full, visit https://www.apma.org/CommentLetters.