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.

ACEP is acting now in hopes of preventing disruption before the policy takes effect or sets a dangerous precedent for other payers.

A Larger Pattern of Insurer Bad Behavior

Emergency physicians know all too well that the effects of policies that narrow insurance networks land squarely on their shoulders, as they are legally required to treat all patients regardless of insurance status. The fight against Anthem’s new policy is one battle in ACEP’s broader campaign to hold insurers accountable when their proposals threaten the stability of emergency care.

As insurer maneuvering has continued to ramp up, ACEP has fought back at every turn. ACEP has continually applied pressure to compel insurance companies to roll back dangerous and frequently unlawful policies, including payment denials, downcoding, reimbursement delays, and other tactics putting emergency departments at financial risk.

Recently, ACEP strongly supported the No Surprises Enforcement Act, which will hold insurance companies accountable for continued and willful violations of the federal law.

The No Surprises Enforcement Act “takes critical steps to level the playing field and stop insurer bad practices,” said Alison Haddock, MD, FACEP, immediate past president of ACEP. “Insurers consistently refuse to play by the rules, doing all they can to delay payments, or in some cases are outright failing to meet their obligations under current law. This bill will hold bad actors accountable and stop their dangerous, irresponsible abuse of the system.”

ACEP remains committed to working with Congress and state and federal regulators to make sure insurance companies conduct business in good faith and in line with current law.

What Comes Next

It is not clear yet whether Anthem plans to revise or withdraw the penalty. ACEP continues to monitor the situation, and ACEP has met directly with Anthem leadership to discuss its concerns.

What is clear is that ACEP will continue to lead efforts to ensure payer policies support the delivery of timely, reliable emergency care. ACEP’s engagement on this issue reflects its commitment to defending the stability of emergency medicine and to making sure emergency physicians have a strong, unified voice whenever insurer decisions threaten the care on which their patients rely.