Elevance Health Expands Out-of-Network Policy

Elevance Health has announced it is expanding its new policy “Facility Administrative Policy: Use of a Nonparticipating Care Provider,” to California effective June 1, 2026. The policy cuts hospital reimbursement by 10 percent when out-of-network physicians provide care and could remove hospitals from Anthem networks for continued use of nonparticipating providers. Read the California policy here.

The policy was initially targeted to the 11 states where it took effect on Jan. 1, 2026.

Elevance Health says it introduced the policy to curb out-of-network providers allegedly misusing the No Surprises Act arbitration process. The policy is intended to deter contracted providers from utilizing out-of-network staffing services.

Exceptions to the policy include emergency services, cases where Anthem has granted prior approval for use of a nonparticipating care provider in the facility‑based setting, and instances when no participating care provider is available to render the same services within the same geographic area. Rural, critical access and safety-net hospitals are also exempt.

Indiana Gov. Mike Braun (R) has signed a bill outlawing the policy in the state over concerns it could block patients’ access to timely care.