Fourteen House lawmakers are calling on federal officials to investigate Elevance Health’s new policy that will penalize hospitals that use out-of-network providers, arguing the approach is anti-competitive and undermines the No Surprises Act.
On Dec. 18, the bipartisan group of physician lawmakers sent a letter to HHS Secretary Robert F. Kennedy Jr., Treasury Secretary Scott Bessent and Labor Secretary Lori Chavez-DeRemer, requesting their departments examine the legality of Elevance’s “facility administrative policy” and scrutinize the insurer’s provider contracting practices.
“We call on the Departments to investigate the legality of this policy, which we believe to be anti-competitive, and to question Anthem’s networking tendencies to better understand how they engage, or fail to engage, in networking negotiations with providers,” the lawmakers wrote.
The letter comes as hospital groups have also pushed back on the policy, which takes effect Jan. 1 and imposes a 10% administrative penalty on claims involving out-of-network providers for Anthem Blue Cross Blue Shield commercial plans in 11 states, along with the potential for network termination.
The lawmakers argued that Elevance’s approach circumvents the independent dispute resolution process established under the No Surprises Act, where providers are winning about 80% of cases that reach arbitration.
“Rather than respond to this clear evidence by adjusting reimbursement to meet medical practice costs, Anthem has instead chosen a concerning path,” the letter states. “Anthem’s new policy attempts to bypass reasonable contract negotiations and IDR and effectively coerce hospitals — many of which are operating on razor-thin margins — to pressure physician groups into accepting unsustainable in-network rates.”
“This tactic places hospitals in an untenable position: either compel physician groups to accept reimbursement that cannot sustain high-quality operations or restrict their patients’ access to high-quality clinicians in order to avoid being penalized by Anthem,” the letter continued. “We are troubled not only by the substance of this policy, but also the preventable harm it will inflict on patients who rely on stable access to hospital-based emergency and specialty care.”
In a Dec. 18 letter responding to the AHA’s call for the policy to be rescinded, Elevance said the policy is “a measured and appropriate step” to address what it characterized as abuse of the IDR process. The company said the policy does not affect emergency care and exempts rural, critical access, and safety-net hospitals. Elevance argued that the disputes driving the policy are “overwhelmingly not for emergencies,” but rather scheduled procedures like plastic surgery, spine surgery, and neuromonitoring services that are often billed by private-equity-backed physician staffing companies. The insurer said its IDR case volume has increased more than 40% in 2025 compared with late 2024.
Elevance also previously shared the following statement with Becker’s:
“The No Surprises Act’s independent dispute arbitration (IDR) process is creating an affordability crisis due to a loophole allowing out-of-network care providers to initiate IDR for claims that are performed at in-network facilities. When the IDR process is abused, costs rise across the system – and that impacts everyone.
Elective procedures that were never meant to qualify for arbitration – like breast reductions – are now generating average IDR payments of $90,000 per case across Anthem’s markets. On average, Medicare would pay approximately $1,100 for this same service and a self-insured employer would pay about $2,400 to an in-network provider.
This surge is powered by private-equity groups and third-party billing companies that encourage out-of-network billing to secure massive arbitration windfalls. Federal agencies expected 17,000 disputes per year; instead, the system is now processing millions. None of this is sustainable, and none of it reflects what Congress intended.
We need our hospital facilities to be part of the solution, since these cases only qualify for IDR when they occur at an in-network facility. Our policy does not apply to emergency services, situations with no in-network alternative, or rural, critical access, and safety-net facilities. This policy is addressing IDR waste and abuse, protecting employer and member affordability, and restoring the NSA to its original purpose. Members will continue to have access to high-quality care, including out-of-network coverage when clinically necessary.”
