The American Academy of Sleep Medicine continues to engage with Anthem (Elevance Health) regarding its recently announced policy affecting coverage and payment for services furnished by non-participating clinicians in non-emergent settings. Earlier this year, the AASM joined a multi-specialty coalition of national and state medical societies in signing on to a letter expressing concern about the potential impact of this policy on patient access, physician autonomy, and the sustainability of independent medical practices.
Following that joint advocacy effort, AASM has remained actively engaged in follow-up communications to ensure the unique clinical and practice considerations of sleep medicine are fully understood. In its response to the coalition, Anthem emphasized that the policy is intended to address rising costs associated with the federal independent dispute resolution process under the No Surprises Act and stated that emergency care, rural hospitals, critical access hospitals, and safety-net hospitals are excluded from the policy at this time. Anthem also indicated that it does not intend to penalize isolated or unavoidable use of non-participating clinicians and expressed willingness to continue dialogue with physician organizations.
The AASM remains concerned about the potential downstream effects of this policy on patient access to timely sleep care, particularly given workforce constraints, facility-based staffing models, and the multidisciplinary nature of sleep medicine services. We will continue to advocate for policies that protect patient access, support fair contracting practices, and avoid unintended consequences for sleep specialists and sleep centers. Members may send questions about this policy to coding@aasm.org.
