Anthem Takes Steps to Reduce Surprise Billings by Non-Network Providers in Network Facilities, Effective January 1, 2026

Since January 1, 2022, the No Surprises Act prohibits non-network providers from billing patients for certain surprise medical bills, which are unexpected bills from non-network providers they never chose. The No Surprises Act also created a process known as Independent Dispute Resolution (IDR) to settle payment disagreements between the Health Plan and those same non-network physicians.

Unfortunately, many of these non-network providers are abusing the IDR process and seeking to extract exorbitant payments from insurers, including our Health Plan, for procedures that fall outside the scope of the No Surprises Act—that is, for non-emergency and/or planned procedures to which the No Surprises Act does not apply. As these abuses not only go against the intent of the No Surprises Act but also contribute to overall healthcare inflation, Anthem has developed a new policy to address these abuses.

Beginning January 1, 2026, Anthem will require network facilities to refer hospitalized patients to network providers with the appropriate skills (e.g., cardiologist, oncologist, orthopedist, etc.), unless there is no such network provider available. If the network facility fails to comply with the policy, Anthem may fine the facility 10% of the allowed amount billed. If the network facility is fined, both the patient and the Health Plan will benefit from the reduced pricing.

This policy will not affect patients, as the No Suprises Act protections prohibiting balance billing on emergency claims will remain in place. Additionally, the new policy only applies when you are receiving care in a network facility that refers you to a non-network provider without your knowledge when a network provider is available. Only the network facility faces a possible 10% penalty. For information on the No Surprises Act, read Your Rights and Protections Against Surprise Medical Bills. For more information on the Health Plan’s reimbursement procedures on non-network benefits, please visit our Non-Network Medical Benefits webpage.