Medical Groups Tell Anthem to drop OON Penalty

Leading medical societies spoke out against an Anthem plan to impose a 10% payment penalty on facility claims involving out-of-network (OON) clinicians, a policy that raises serious legal and ethical questions, shifts Anthem’s network adequacy responsibility to hospitals and other facilities, and jeopardizes continuity of care and patient access to essential services.

In a letter to Anthem leadership, the American College of Radiology® (ACR®), American College of Emergency Physicians (ACEP) and American Society of Anesthesiologists (ASA) urged the insurer to immediately abandon the policy, which is set to take effect in January 2026 and threatens to remove sites from Anthem’s network for continued use of out-of-network clinicians. 

The organizations write: 

“This policy is deeply flawed and operationally unworkable. It effectively shifts Anthem’s network adequacy obligations onto facilities, holding them financially liable for the contracting status of independent physician groups—an area over which they have no control or infrastructure to manage. 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.

Provider staff privileging decisions are based on quality, competence, and credentials—not insurance participation. Expecting facilities to monitor and enforce payer contracts across dozens of independent entities and multiple commercial plans is not only impractical but raises serious legal and ethical concerns.” 

The policy is a blatant attempt to subvert the federal No Surprises Act (NSA), which already provides a fair and balanced mechanism to resolve facility-insurer OON care payment issues, keeping patients entirely out of the process. Network adequacy is the responsibility of insurers, not hospitals, and is a fundamental element in incentivizing good-faith negotiations between physicians and insurers. 

ACEP, ACR and ASA urge Anthem to immediately reconsider this policy for a more sustainable and collaborative approach to network adequacy and clinician contracting that respects the clinical autonomy of medical professionals and ensures uninterrupted access to high-quality care for patients.