Anthem’s Attempt to Force Physicians Into Network Participation
Click to Enlarge
Colleagues:
Another week, another attempt by a health insurer to throw sand in the gears of health care delivery.
A group of MSSNY physician members brought the latest challenge to our attention: Anthem’s attempt to coerce physicians into network participation by penalizing hospitals with a 10% financial penalty if a non-participating physician is involved with the patient’s treatment. While New York is not one of the 11 states where this policy is being planned for implementation on 1/1/2026—and there is a good argument to make that such policy would not be even be legal in New York—we are greatly concerned about the precedent of this initiative.
Despite having a small staff and extremely limited resources, MSSNY’s Executive Vice President Tom Lee, MD and Senior Vice-President & Chief Legislative Counsel Moe Auster immediately jumped into action this week. Together they drafted an AMA House of Delegates emergency resolution calling on the AMA to 1) advocate for legislation, regulation, or other intervention to prevent health insurers from threatening hospitals and other facilities with payment cuts, administrative or penalty fee imposition, network termination, or other negative financial policies if an out of network physician is involved in the treatment of care for a patient at these hospital or facilities and 2) collaborate with specialty societies and state medical societies to develop model legislation to oppose such unfair and coercive business practices that undermine patient access and physician practices. The resolution was approved by the MSSNY Executive committee. Then, through diligent follow-up, Dr. Lee and Mr. Auster were able to convince 11 other state medical societies and 5 specialty societies to join the effort. We thank those state associations and specialty societies who have joined as co-sponsors of this resolution.
After Dr Lee alerted the AMA CEO and BOT Chair to this policy, the AMA expeditiously developed a federation sign-on letter for state and specialty medical associations to Anthem urging them to retract this new policy. The letter suggests that Anthem is attempting to bypass the federal No Suprises Act (NSA) that protects patients from surprise medical bills when out-of-network care is provided at an in-network hospital. It also raises concerns that this policy will facilitate even greater consolidation in healthcare delivery by forcing many types of specialist physicians to face no choice but to become hospital employees. Worst of all, it poses the risk of already understaffed hospitals having even more limited physician availability for patients in need or emergency or urgently needed care.
Rather than implementing a policy with so many negative consequences, the AMA urges Anthem to consider adopting policies that incent physician participation in their networks, such as offering fair and competitive contracts that allow physician practices to employee appropriate staff, invest in innovation, manage administrative requirements, and promote physician wellness.
This rapid response sequence implemented by MSSNY to respond to the concerns of our physician members demonstrates the importance of member engagement and hard work by staff. This situation began with MSSNY members bringing the issue to our attention and was followed by the initiative of senior staff and input by leadership to take action—and concluded with final execution by the staff. The MSSNY Executive Committee now meets weekly and is specifically redesigned to allow your leadership to respond quickly to the needs of you—our members.
Stay tuned for further updates. MSSNY will not stand by idly as another insurance company attempts to limit our patients’ access to needed care.
If you are a member, please renew your membership now. If you are not a member and are a NYS Physician, please join. Also, please give to our PAC.
All the best,
David Jakubowicz, MD, FACS
MSSNY President
