Elevance Health’s out-of-network penalty policy has been met with significant resistance — and another lawsuit filed Sept. 17 is adding fuel to the fire.
The Neurological Surgery Practice of Long Island filed the complaint in a New York federal court, targeting a policy that expanded to the state in July. Under the policy, network hospitals and ASCs are hit with a 7.5% administrative penalty reduction on reimbursement when they allow out-of-network clinicians to treat commercial members.
“Anthem’s policy does not target unlawful balance billing or patient complaints,” the lawsuit said. “Instead, it targets the use of nonparticipating physicians regardless of whether the physician complied with the No Surprises Act, accepted the statutory balance-billing prohibition, and used the federal [independent dispute resolution] process.”
The complaint also brought antitrust claims, saying the insurer is “a dominant commercial payer and must-have buyer of hospital facility services in the New York metropolitan area.”
Elevance has defended the policy as a reaction to the No Surprises Act’s independent dispute resolution process, with most disputes decided in favor of providers. However, providers have expressed concerns over the financial viability of independent physicians and whether providers could feel pressured into certain insurance networks.
The California Hospital Association pursued legal action over the policy earlier in 2026, as well. Additionally, Indiana, Elevance’s home state, enacted a law pushing back against these penalties.
“We are aware of the lawsuit challenging this policy and will respond through the appropriate legal process. The policy is designed to help protect members from unnecessary out-of-network costs. For planned, non-emergency care at an in-network facility, we want to ensure members receive care from in-network providers when they are reasonably available,” Elevance told Becker’s Sept. 18. “The policy also addresses inappropriate use of the No Surprises Act’s dispute resolution process, which can increase healthcare costs and premiums. Patients and employers should not have to pay excessive out-of-network charges for planned care when in-network options are available.”
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