ACEP is urging Anthem to withdraw a new policy that will penalize hospitals when care is delivered by an out-of-network clinician.

Effective January 1, 2026, facilities will see a 10 percent payment cut on claims involving an out-of-network physician. Anthem’s new policy will affect plans in 11 states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Wisconsin. The insurer has also indicated that in time it may terminate hospitals from its network after continued use of out-of-network clinicians.

An Anthem spokesperson said in an interview that the policy is intended to streamline care. “This new policy encourages care to be delivered by in-network providers while visiting in-network facilities, which helps provide a smoother member experience, improve affordability and reduce unnecessary administrative complexity.” 

However, in a letter to Anthem leadership, ACEP joined the American Society of Anesthesiologists (ASA) and the American College of Radiology (ACR) in warning that the new policy will destabilize physician staffing and undermine patient access to care.

Although emergency services are technically exempt, the policy threatens emergency physician groups because it shifts the insurer’s network adequacy obligations onto hospitals, holding them financially responsible for the contracting status of independent physician groups. As a result, emergency physicians and clinicians across other specialties will face increased pressure, contracting uncertainty, and potential disruptions in continuity of patient care.

ACEP and its partner societies raised concerns that hospitals facing the penalty will be incentivized to pressure contracted groups into joining Anthem’s network, regardless of whether Anthem’s terms are sustainable. This could threaten the viability of independent practices and democratic groups, or force sudden shifts in staffing arrangements.

“Hospitals will be forced to compel independent providers to join Anthem’s network under unfavorable terms, leading to a risk of worsening financial instability and loss of clinicians. The need to reorganize or replace physician groups will jeopardize hospitals’ continuity of care and patient access to essential services,” the societies said in the joint letter.

ACEP was also part of another joint letter pushing back on the penalty. The letter underscored that Anthem’s approach undercuts the intent of the federal No Surprises Act, which already provides a mechanism for resolving out-of-network payment issues.

“We are dismayed that Anthem is attempting to bypass the negotiated bipartisan policy under the No Surprises Act (NSA) that protects patients from surprise medical bills when out-of-network care is provided at an in-network hospital. We find it very concerning that rather than working through the NSA, Anthem is choosing to implement a policy that essentially circumvents the statute,” ACEP and its partner groups said in the letter.