Anthem’s Policy on Out-of-Network Providers: What It Means for Hospitals and Clinicians 

Navigating the twists of U.S. healthcare policy can feel like decoding a puzzle that changes every few months. The latest piece comes from Anthem Blue Cross and Blue Shield—now part of Elevance Health—with a new administrative policy targeting how hospitals handle out-of-network physicians. Rolled out on October 1, 2025, and set to kick in January 1, 2026, it focuses on “nonparticipating care providers” in facility-based care, like radiology reads during outpatient procedures or inpatient stays. This affects commercial plans in 11 states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Wisconsin.