AHA urges Elevance Health to rescind Anthem’s ‘Nonparticipating Provider Policy,’ citing harm to patient care access

The AHA Dec. 17 urged Elevance Health, which is the parent company of the Anthem brand of health plans, to rescind Anthem’s nonparticipating provider policy that is set to go into effect Jan. 1, citing the harm it will inflict on patients.

Effective Jan. 1, 2026, Anthem intends to impose punitive measures on hospitals participating in the plan’s network in instances where an out-of-network provider is part of an Anthem enrollee’s care team. Under the policy, Anthem could penalize hospitals equal to 10% of the allowed amount of the hospital’s claims that involve the use of an out-of-network provider and potentially terminate the hospital from its networks. Penalties and termination can be applied to hospitals under the policy even though hospitals may not own, control or manage independent providers involved in a patient’s care.

“Specifically, Anthem’s approach would limit patients’ choice of providers and could even mislead them about where they can access care,” AHA President and CEO Rick Pollack wrote to Elevance Health.

The AHA strongly urged Elevance to rescind the policy and work directly with applicable out-of-network providers to address their concerns and, if that fails, participate more meaningfully within the No Surprises Act Independent Dispute Resolution process.

“The core objectives of the NSA were to protect patients and to incentivize network participation,” the AHA said. “Anthem undermines this landmark legislation by introducing new patient harms and targeting the very hospitals that have worked in good faith to participate in the plan’s network. The AHA calls on Elevance Health to do right by its Anthem enrollees and ensure it is a credible partner to its network hospitals and health systems and rescind this deeply flawed policy.”