A new policy by the health insurer Anthem will penalize hospitals for using doctors outside of its coverage network.
Anthem claims the move is designed to reduce its members’ out-of-pocket costs. But critics argue it will force medical facilities to police physicians’ network status, strong-arm doctors into accepting lower payments from health insurance companies, and could lead to fewer care options for patients.
According to the new policy, which will take effect on January 1, Anthem will cut a hospital’s reimbursements by 10 percent whenever the facility submits a claim that includes services from out-of-network providers. Additionally, hospitals that rely on out-of-network service providers will risk “potential termination from Anthem’s networks,” according to Anthem’s notice.
The policy will impact plans across eleven states, including Colorado, Georgia, and New Hampshire — all of which are managed by Elevance Health, a multibillion-dollar health company that operates Anthem Blue Cross and Blue Shield plans across fourteen states and serves millions of people.
In a policy update for New Hampshire facilities, Anthem states that in order to “support patient care, and to help reduce out-of-pocket expenses for our members, it is essential that members are directed to care providers participating in our Anthem network.”
A spokesperson for Elevance Health reiterated potential patient benefits in an email to the Lever.
“This policy will encourage fair contracting and reduce abuse, resulting in better affordability, quality, and enhanced protection for members from surprise medical bills,” she wrote.
However, medical professionals say this policy will force facilities to police whether their providers are in-network with Anthem — something that is “not only impractical but raises serious legal and ethical concerns,” according to a letter sent this month by three medical societies to Elevance Health’s…
Auteur: Helen Santoro
