Source Article: MedPage Today Medical Groups Outraged by Anthem Payment Policy Change

As of January 1, 2026, Anthem BCBS said that it will begin to enact a 10% payment penalty for hospitals in 11 states if patients insured by them receive care from out-of-network (OON) physicians.  Anthem’s 10% penalty exists because the No Surprises Act (2022) makes out-of-network care expensive for insurers as they still have to OON clinicians the median in-network rates and additional costs are not passed along to the patient.

Ariel Bayewitz, MPH, vice president for health economics at Elevance Health (Anthem’s parent company), told MedPage Today “The new policy only applies to non-emergent situations in which out-of-network physicians continue to practice at in-network hospitals.” All hospitals in rural and safety-net areas will be carved out “for now,” he said. “If suddenly things change and those become huge problems with IDR, we will revisit it.”

The states included are:

• Colorado
• Connecticut
• Georgia
• Indiana
• Kentucky
• Maine
• Missouri
• Nevada
• New Hampshire
• Ohio
• Wisconsin

For more information on the medical groups included in a letter to Elevance Health pushing back on this change see the complete article, listed above.