Elevance Health has shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states.
Under the policy, finalized Oct. 1 and effective Jan. 1, facilities could face “an administrative penalty equal to 10% of the allowed amount of the facility’s claims that involve the use of nonparticipating care providers.” Providers cannot have members cover this penalty, and they could also be terminated from Anthem’s network under the new policy.
Anthem outlined exceptions for emergency services and when the insurer issues prior approval.
“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,” a spokesperson told Becker’s. “Members will not see any disruption to their care. Out-of-network care will continue to be covered in emergency situations and when no options exist for in-network providers.”
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