AHA: Anthem facility administrative policy sets providers up to fail

In a commentary published March 26 by Healthcare Dive, AHA President and CEO Rick Pollack details why a new facility administrative policy from Anthem will make it tougher for individuals to access health care. The policy requires hospitals in 12 states to guarantee that every physician treating an Anthem enrollee is an in-network provider. “Framing this as an altruistic gesture that protects patients, the timing and draconian penalties for hospitals for noncompliance suggest something far more cynical, and that is Anthem’s desire to avoid what it sees as flaws in the No Surprises Act and specifically the law’s independent dispute resolution process,” Pollack writes. “The new policy launched Jan. 1 threatens to cut hospital payments by 10% or even remove the hospital from its network if it fails to comply. Upon closer look, this policy appears designed to pressure independent physicians into contracting with Anthem on its terms and force hospitals to serve as Anthem’s enforcement arm — an unethical and impossible mandate on both fronts.” READ MORE