Anthem Expanding Policy that Punishes Hospitals Who Use Out-of-Network Radiologists

Why It Matters

The policy shifts financial pressure from insurers to hospitals, potentially limiting patient access to specialist care and reshaping payer‑provider dynamics in a post‑No Surprises Act landscape.

Key Takeaways

• Anthem adds 10% penalty for out‑of‑network radiologist claims
• Policy now expands to California, the 12th state
• Indiana law blocks the policy within the state
• Physicians warn of reduced access to specialist care
• No‑Surprises Act leaves patients’ out‑of‑pocket costs unchanged

Pulse Analysis

Anthem’s expansion of its non‑participating provider policy reflects a broader insurer strategy to curb out‑of‑network spending after the No Surprises Act curbed surprise billing. By imposing a 10% administrative charge on any hospital claim that includes an out‑of‑network radiologist, the company aims to steer self‑funded plan members toward in‑network providers, arguing that this will lower overall out‑of‑pocket costs. The policy’s rollout now includes California, joining ten other states where hospitals must either comply or risk network termination, with limited exemptions for emergencies and small facilities.

Physician groups and state legislators have quickly mobilized against the move, warning that it could erode access to specialized imaging services. Independent radiology practices, which often rely on hospital contracts, fear reduced referral volumes and financial strain. Indiana’s Senate Bill 189 already blocks the policy, citing potential harm to patient care and provider autonomy. Similar opposition is emerging in California, where large imaging networks like Rad Partners argue the penalty undermines the bipartisan intent of the No Surprises Act and could force patients into suboptimal care pathways.

The controversy underscores a growing tension between insurers seeking cost control and providers defending clinical independence. Legal challenges are likely, as stakeholders question whether the penalty violates antitrust principles or the spirit of federal surprise‑billing reforms. If courts curb the policy, insurers may pursue alternative mechanisms, such as tighter network negotiations or revised arbitration processes. For hospitals and radiology groups, the key will be navigating these regulatory shifts while maintaining patient access and financial viability.