Medical Associations Tell Anthem: Drop Legally Questionable Penalty on Clinicians Pushed Out of Network

WASHINGTON, D.C. — 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 Society of Anesthesiologists (ASA), American College of Emergency Physicians (ACEP) and American College of Radiology® (ACR®), 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.

ASA, ACEP and ACR 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.

About the American Society of Anesthesiologists 
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 60,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.

About the American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org. 

About the American College of Radiology 
The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.

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