Earlier this week, CHA sent a pointed letter to the president of Anthem Blue Cross of California, calling out the insurance behemoth’s new multistate payment policy — an unjust and harmful practice that will penalize California hospitals for providing care to patients involving non-participating physicians or providers.
The letter conveys a line in the sand for California hospitals. The patients and communities you serve should not and cannot be forced to suffer while Anthem continues to pocket record sums of cash, billions of dollars in profit in 2025 alone.
For starters, as the letter notes, the policy is illegal under California’s ban on economic credentialing, where hospitals are barred from requiring a physician to be in the same network as the hospital. From the letter: “… California law explicitly prohibits a hospital from conditioning clinical privileges or medical staff membership on a physician’s participation in specific insurance contracts. By penalizing hospitals for the participation status of independent clinicians — which hospitals are statutorily prohibited from managing in California — Anthem is forcing facilities to choose between significant financial penalties and violating state law.”
The letter goes on to detail how the true driver of out-of-network “challenges” for Anthem is the simple fact that Anthem has failed to maintain an adequate network of physicians or to offer fair rates for reimbursement: “The very impetus for this policy suggests that Anthem’s networks may be inadequate. If enough care is being provided [out of network] to warrant such a penalty, the failure lies with the plan’s contracting and business practices, not the participating hospital facilities that have contracted with Anthem in good faith.”
We’ve shared this letter with top leaders at the California Department of Managed Health Care, to underscore Anthem’s failure to maintain adequate networks of doctors. While the Anthem policy only applies to self-insured products regulated federally under the Employee Retirement Income Security Act of 1974 (ERISA), not state-regulated insurance plans, it’s vital that state regulators are aware of the impact to patients resulting from this policy and of Anthem’s failure to maintain even baseline network adequacy for millions of Californians.
At the national level, the American Hospital Association is also weighing in. An op-ed from AHA President & CEO Rick Pollack pointed out: “Nothing about this new policy improves care or solves issues of access, rather it creates new ones for Anthem patients. It will make fewer doctors available to them and potentially make a trusted hospital no longer an option. The fact that Anthem would choose to do this at a time when our healthcare system is confronting some of the most destabilizing forces in history suggests a troubling disregard for patients.”
We’ve amplified AHA’s poignant message for state lawmakers through our digital channels and will continue to press on every available front to undo a policy that serves only to feather Anthem’s nest on the back of patients and hospitals.
