Anthem Is Cutting Access to Out-of-Network Doctors
15 days ago
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- #policy
- #insurance
- Anthem is introducing a policy to penalize hospitals for using out-of-network doctors, reducing reimbursements by 10% and risking network termination.
- The policy aims to lower out-of-pocket costs for members but may limit patient care options and disrupt hospital operations.
- Medical professionals criticize the policy, citing impracticality, legal concerns, and potential care disruptions.
- Hospitals may be forced to replace physician groups, leading to delays in procedures and gaps in essential services like anesthesia.
- Patients could lose access to quality providers if their preferred doctors are out-of-network with Anthem.
- Critics argue the policy skirts the No Surprises Act, which protects patients from surprise medical bills.
- Insurers have previously used loopholes in the No Surprises Act to pressure providers into accepting lower payment rates.
- Anthem's policy is seen as a way to boost profits while undermining fair negotiations between insurers and providers.
- Elevance Health claims the policy addresses abuse of the independent dispute resolution process under the No Surprises Act.
- The policy follows similar profit-driven moves by UnitedHealthcare and Cigna, such as network cuts and downcoding.