December 9, 2025
Alexandria, VA—Yesterday, the Ambulatory Surgery Center Association (ASCA) and a coalition of 33 healthcare organizations joined together to oppose a new policy from Anthem that requires healthcare facilities to shoulder the burden of network accuracy or face potentially severe penalties.
Effective January 1, 2026, facilities participating with Anthem in 11 states must ensure that all providers delivering services to Anthem beneficiaries are in-network or face corrective measures. Those measures range from a 10 percent cut to all claims involving an out-of-network provider to wholesale termination from Anthem’s network.
“Surgery centers frequently rely on contracted anesthesia, pathology and radiology groups, all of which could be in-network at the time of agreement but can fall out-of-network without notice, something ASCs have no control over,” said Bill Prentice, chief executive officer of ASCA. “Without timely and accurate information from Anthem about changes in status of contracted providers involved in care between the time a surgery is scheduled and when it is performed, the burden of verification wrongly falls on ASCs, with significant penalties lurking behind any missteps.”
The policy will affect Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin. Although Anthem will allow for nonparticipating providers in certain circumstances, such as emergency services and instances of prior approval in specific cases, the insurer has not made it clear how those authorizations will work or whose responsibility it will be to obtain authorization. If implemented, there is little preventing Anthem from expanding the policy to impact other states or other insurers from following Anthem’s lead.
Read the coalition letter opposing Anthem’s new policy.