ISMA signed onto a letter with the AMA Federation to seek rescission of a new Anthem policy (Facility Administrative Policy: Use of a Nonparticipating Care Provider) scheduled to be implemented in 11 states (CO, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI) starting January 1, 2026. Under the new policy, Anthem Blue Cross and Blue Shield plans will begin penalizing hospitals with a 10 percent reimbursement cut when out-of-network physicians are used in the provision of care. The policy also indicates that Anthem will consider terminating hospitals from its network for continued use of nonparticipating physicians.

The implementation of this policy as it seems to be a workaround of the compromise reached under the No Surprises Act, a 2022 law designed to protect consumers from unexpected medical bills, particularly in situations involving out-of-network providers. More importantly, the policy is bound to put pressure and strain on independent physician practices, as well as reduce access to care for patients.

While this policy applies initially to only 11 states, it could spread to other states and payers.