The American Academy of Sleep Medicine has also signed on to a multispecialty coalition letter urging Elevance Health/Anthem to immediately rescind its newly announced Facility Administrative Policy: Use of a Nonparticipating Care Provider.
The policy, set to take effect Jan. 1, 2026, would impose a 10% payment penalty on hospitals when any out-of-network physician provides care and could lead to hospitals being terminated from Anthem networks if nonparticipating clinicians continue to practice there.
Implementation of this policy could significantly disrupt practice operations and patient access, leading to delays in care, narrowed access to hospital-based specialists, and challenges in rural settings where hospital options are already limited. Anthem enrollees who pay for out-of-network coverage may also see the value of their benefits diminished.
The policy also bypasses the protections in the No Surprises Act and threatens the financial viability of independent physician practices, including many in sleep medicine. As noted in the letter, hospitals are unlikely to absorb these cuts, placing pressure on physicians to accept potentially unfavorable contracts or shift to employment models.
AASM remains committed to advocating for policies that enhance patient access to sleep medicine services, reduce barriers to essential care, strengthen the physician workforce, and protect patient access to comprehensive, team-based care.
Please send questions regarding AASM support for prior authorization reform or the Anthem policy to coding@aasm.org.
