Rick Pollack is the president and CEO of the American Hospital Association. This opinion piece explores Anthem Blue Cross Blue Shield’s new facility administrative policy. In the coming days, Healthcare Dive will publish Elevance's response to AHA's position.
As millions of Americans began 2026 facing skyrocketing premiums and the possibility of losing coverage altogether, corporate insurers seem undeterred in their continual efforts to implement policies that make access to healthcare even harder.
The latest example comes from Anthem Blue Cross Blue Shield, an Elevance subsidiary, who kicked off the new year with a new “Facility Administrative Policy” that now requires hospitals in 12 states to guarantee that every physician treating an Anthem enrollee is in-network. 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.
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. Hospitals have zero control over which independent physicians join an insurer’s network, nor can they confirm which physicians are in-network because Anthem’s own provider directories are outdated or incorrect. In short, this new policy sets providers up to fail and seeks to create challenges for an important patient protection from surprise medical bills.
Nothing about this new policy improves care or solves issues of access, rather it creates new ones for Anthem patients. It will make fewer doctors available to them and potentially make a trusted hospital no longer an option. The fact that Anthem would choose to do this at a time when our healthcare system is confronting some of the most destabilizing forces in history suggests a troubling disregard for patients.
If Anthem truly wants to address its dissatisfaction with the IDR process, there are more effective ways to do that. The company could:
- Use federal coding standards to clearly identify which claims are eligible for IDR.
- Participate fully in the IDR process to avoid automatic default rulings.
- Engage in good-faith negotiation by responding to provider offers promptly and substantively.
- Propose fair payment offers that arbitrators are more likely to select.
Hospitals want to work together with insurers and physicians to make sure patients get the care they need from the clinicians and facilities they trust. Anthem should focus on improving its own processes — not passing down unrealistic mandates that weaken protections designed in the No Surprises Act to keep care accessible and affordable for patients.
