Medical Societies Urge Anthem to Drop 10% Out-of-Network Penalty Policy

Three leading medical societies — the American College of Radiology (ACR), American College of Emergency Physicians (ACEP), and American Society of Anesthesiologists (ASA) — are calling on Anthem Blue Cross and Blue Shield to withdraw a new policy that would impose a 10% administrative penalty on facility claims whenever an out-of-network (OON) clinician participates in the episode of care. The policy is scheduled to take effect January 1, 2026.

In a joint letter to Anthem, the organizations warned that the policy is “deeply flawed and operationally unworkable,” arguing it:

• Shifts network adequacy responsibility from insurers to hospitals
• Forces facilities to police the contracting status of independent physician groups
• Risks care disruptions if hospitals must reorganize or replace clinical staffing
• Raises legal and ethical concerns, particularly around privileging and independence of medical decision-making
• Potentially conflicts with the No Surprises Act, which already governs OON billing and protects patients

The groups argue that holding facilities financially liable for the insurance participation status of radiologists, emergency physicians, anesthesiologists, and other independent clinicians is inappropriate and may threaten access to essential services.

If implemented, the policy could lead to significant claim reductions, increased appeals, contracting pressure on physician groups, and operational disruption for hospitals.

Source: https://www.acr.org/News-and-Publications/Media-Center/2025/medical-groups-tell-anthem-to-drop-oon-penalty