IT Sourcing and Vendor Management Intern

Elevance will stop paying hospital rates for some off-campus clinic care, a shift that could trim facility fees. Published Sep 30, 2026 9:39 PM EDT By Cole Mercer Elevance Health, the insurer behind Anthem plans, said Sept. 29 that it will stop paying hospital rates for certain care delivered at hospital-owned clinics located away from the main hospital campus. According to the company's announcement of new billing transparency policies, those services will instead be paid at the lower off-campus rate. The policies will roll out during 2026 and 2027 across its commercial, Medicare Advantage, and Medicaid plans. The change targets a billing practice that surprises many families. When a hospital system buys a neighborhood doctor's office, the same visit with the same doctor can be billed as hospital outpatient care, often with an added facility fee. Elevance, whose companies serve about 104 million people, said one member's bill rose to more than 10 times the normal amount because of this kind of billing. For households, the concern is practical. Higher payments flow into deductibles, coinsurance, and premiums, so a routine visit, lab test, or imaging scan can cost more depending on who owns the building rather than what care was provided. Same doctor, same visit, higher bill. Site-of-care billing refers to paying a claim based on where care happens. Medicare and many commercial plans have long paid more for services in a hospital outpatient department than in an independent physician's office. Hospitals say facility fees help pay for round-the-clock staffing, equipment, and stricter regulatory standards. The problem arises when a clinic miles from the hospital is registered as a hospital department. Patients may receive two bills, one from the physician and one for the facility, even though the office looks and works like any other practice. Claims have not always shown clearly where care actually took place. The costs add up nationally. Elevance cited a 2023 Blue Cross Blue Shield Association analysis finding that, for four common services, Medicare paid an additional $2.7 billion and patients paid $411 million more out of pocket over three years when the services were delivered in hospital outpatient settings instead of physician offices. Federal health spending data show hospital care reached about $1.6 trillion in 2024, roughly 31% of U.S. health spending. Inside Elevance's new billing rules. Under the new policies, hospitals must identify the physical location where care was provided. Elevance will check billing information against hospital addresses, pay certain off-campus services at the off-campus rate, and block higher hospital billing for some lab tests performed elsewhere. The company says it is the first commercial insurer to announce that it will require location on billing forms. Elevance announced the policies at the Make America Healthy Again (MAHA) Summit in Washington. "These changes will give us better information to help us pay accurately and support our work to make health care more affordable," said Dr. Catherine Gaffigan, president of health solutions at Elevance. "Increasingly, our customers demand affordability, and we have a responsibility to deliver that to them," she said, adding that the actions will help the company address wasteful spending and manage premiums. The move follows state and federal action. Elevance noted that Indiana and Maine have strengthened billing requirements for off-campus care. Separately, a provision in a bipartisan spending law Congress passed earlier this year will require off-campus hospital departments to bill under their own unique National Provider Identifier numbers starting in 2028, Fierce Healthcare reported. States are also enforcing disclosure rules. On Sept. 25, Maryland Attorney General Anthony G. Brown announced that the University of Maryland Medical System would pay $2,251,781.52 in restitution to certain patients who paid out-of-pocket facility fees at some of its hospital clinics before the state's Facility Fee Right-to-Know Act took effect on July 1, 2021. The health system denied that patients had been inadequately informed but agreed to the settlement. Eligible patients should receive refund checks over the next six months. Savings could be modest, and key details are missing. Independent analysts welcomed the direction but cautioned against expecting large savings. Loren Adler, a fellow and associate director of the Brookings Institution's Center on Health Policy, told Axios that the policy should lower prices, but "the magnitude is unlikely to be terribly large." He also said he did not have a good sense of why insurers had not acted sooner. Important questions remain unanswered. Elevance's announcement does not list which services are affected, which states or plans will see changes first, exact start dates, or how much member cost sharing will fall. It also does not say whether hospitals will be barred from billing patients separately for facility fees that Elevance declines to pay at hospital rates. Hospital groups have long defended facility fees as necessary to support hospital infrastructure, so lower payments could become a point of tension in contract negotiations. Protecting yourself from surprise facility fees. People with Anthem or other Elevance plans do not need to take immediate action, since the changes phase in through 2027. Still, patients can reduce surprises now. Before a nonemergency visit, ask whether the clinic is hospital-owned and whether a separate facility fee applies. Review each explanation of benefits for two charges on the same date, one professional and one facility. If your doctor's office was recently bought by a health system, compare your costs before and after. Ask whether lab work or imaging can be done at an independent site, which may cost less. If a bill seems wrong, call your insurer and ask for an itemized statement. Maryland residents can contact the attorney general's Health Education and Advocacy Unit for help with billing disputes, and many states offer similar consumer help lines. Patients who struggle to pay can ask about financial assistance, which nonprofit hospitals must offer under federal tax rules. Elevance's changes move billing toward paying for care based on where it actually happens, but how much families will save remains unclear until the company releases service lists and effective dates. Key questions answered. What is Elevance changing? It will require hospitals to report where care took place and will pay certain services at hospital-owned off-campus clinics at off-campus rates instead of higher hospital rates. What is a facility fee? A facility fee is a charge a hospital adds for the use of its space, staff, and equipment. It is often billed separately from the doctor's fee, even at clinics away from the main hospital. When will members see changes? Elevance says the policies will roll out during 2026 and 2027. It has not published specific dates by service or state. Will my out-of-pocket costs drop? Possibly, but Elevance has not said by how much. A Brookings health policy expert expects the overall effect on prices to be modest. How can I avoid a surprise facility fee? Ask before a visit whether the clinic is hospital-owned and whether a separate facility fee applies, and review each explanation of benefits. Who is getting money back in Maryland? Certain patients who paid out-of-pocket facility fees at some University of Maryland Medical System hospital clinics before July 1, 2021, will receive refunds under a settlement announced Sept. 25. Published by Medicaldaily.com

Strive Health expands executive team to support next phase of growth. New leaders bring deep healthcare expertise across operations, provider networks and enterprise growth Susan Ray, Chief Operating Officer; Sarah Berry, Ph.D., Chief Network & Engagement Officer; Dan Heslin, Chief Growth Officer. DENVER-(BUSINESS WIRE)-Strive Health, the national leader in value-based kidney care, today announced three additions to its executive leadership team to expand its national footprint and deepen its partnerships with payors and providers. Susan Ray has joined Strive as Chief Operating Officer (COO), Sarah Berry, Ph.D., as Chief Network & Engagement Officer (CNEO) and Dan Heslin as Chief Growth Officer (CGO). Together, they will lead three critical areas of Strive's next phase of growth: delivering its care model consistently at scale, strengthening the performance and engagement of its national provider network and expanding access to value-based kidney care through new and existing partnerships. "Scaling value-based care requires strong execution, deeply engaged provider partners and solutions that deliver value for our patients and customers," said Paul Marchetti, Strive's President. "Susan, Sarah and Dan bring proven expertise in building and leading complex healthcare organizations. Their leadership will help us continue to improve how care is delivered for people with kidney disease and comorbidities as we reach more patients nationwide." As COO, Ray will lead Strive's market operations and central services, overseeing customer relationships and the teams responsible for executing the company's care model at the point of delivery. Ray brings deep experience across value-based care, operations, client management and organizational transformation. Most recently, she served as COO of Rippl Care, where she helped build and scale a care model for individuals living with dementia. She previously held senior leadership roles at Honest Health, naviHealth, Evolent Health and Accolade. Berry will oversee the company's network of more than 6,500 provider partners as CNEO, along with engagement functions that connect patients with timely local care and Strive's clinical and social needs programs. Berry most recently served as SVP of clinical service operations at Ventricle Health, where she led the scaling and performance of its advanced heart failure cardiology network and clinical operations. Previously, she held senior network and operational leadership roles at Aetna (a CVS Health Company), Innovation Health and Evolent Health. As CGO, Heslin will lead Strive's business development strategy, strategic partnerships, marketing and market expansion, with a focus on bringing the company's population health solutions and partnerships across payors, providers and other healthcare organizations. Heslin joins Strive following an extensive career at Elevance Health, where he held leadership roles spanning enterprise growth, product strategy and business development and most recently served as president of the company's specialty business. Earlier in his career, he held roles at Roche Diagnostics and in technology strategy consulting. The appointments strengthen Strive's leadership across the full lifecycle of its value-based care model - from building new partnerships and engaging provider networks, to delivering care consistently for patients and customers nationwide. ABOUT STRIVE HEALTH Strive Health is the nation's leader in value-based kidney care and partner of choice for innovative healthcare payors and providers. Using a unique combination of technology - including AI - care interventions and seamless integration with local providers, Strive forms an integrated care delivery system that supports the entire patient journey from chronic kidney disease (CKD) to end-stage kidney disease (ESKD). To help patients, Strive partners with commercial and Medicare Advantage payors, Medicare, health systems and physicians through flexible value-based payment arrangements, including risk-based programs. Strive serves over 165,000 people with CKD and ESKD across 50 states and partners with over 6,500 providers. Strive's case management and population health programs are accredited by the National Committee for Quality Assurance (NCQA), and its technology platform, CareMultiplier(TM), is certified by HITRUST. To learn more, visit StriveHealth.com. More News From Strive Health DENVER-( BUSINESS WIRE )-Strive Health, the leading U.S. value-based kidney care company, was named one of the World's Top HealthTech Companies by TIME and Statista Inc. for a second consecutive year. The full award list can be viewed on Time.com.The World's Top HealthTech Companies 2026 ranking recognizes leading innovators that are advancing healthcare with the support of technology. Out of thousands of healthcare technology companies reviewed, the top 500 were honored. Companies were evaluate... DENVER-( BUSINESS WIRE )-Strive Health, the national leader in value-based kidney care, has welcomed two new members to its executive team. Jamie Sharp, M.D., has been named chief medical officer and will oversee Strive's clinical strategy and performance. Serving as chief financial officer, Chris Rigg will drive financial strategy and operations, while helping scale the business and deploy AI technologies."As Business Wire, Inc. continue to build on Strive's strong momentum, Jamie and Chris stood out as the rig... DENVER-( BUSINESS WIRE )-Strive Health, the national leader in value-based kidney care, welcomes Keith Bellovich, D.O., as its Chief Nephrologist. In this role, Dr. Bellovich will partner with the Chief Clinical Officer and other clinical leadership to drive the development of clinical programs, establish best-practice protocols and oversee a team of providers dedicated to delivering high-quality, evidence-based care for people living with kidney disease. "Dr. Bellovich brings exactly the combi... Strive Health. Release Versions

Neurosurgeons sue Elevance over policy penalizing facilities that work with out-of-network physicians. A Long Island neurosurgery practice has filed a federal antitrust lawsuit against Elevance Health, the parent of Anthem Blue Cross and Blue Shield, over a policy that penalizes in-network hospitals and ambulatory surgery centers when out-of-network physicians treat patients there. Neurological Surgery Practice of Long Island PLLC filed its complaint on September 17, 2026 in the U.S. District Court for the Eastern District of New York. The case is Neurological Surgery Practice of Long Island, PLLC v. Elevance Health Inc. et al., case number 1:26-cv-05756. The policy at the center of the suit reached Elevance's New York health plans in July, after the insurer introduced it in a dozen other states earlier this year. In New York, where Elevance administers plans under the Anthem Blue Cross and Blue Shield of New York name, an in-network facility that allows nonparticipating providers to treat Anthem commercial members can face an administrative penalty of 7.5% of the allowed amount on the affected claims, along with potential termination from Anthem networks. In other states Elevance has set the penalty at 10%. The policy does carve out emergency services, cases where Anthem approves a nonparticipating provider in advance, situations where no in-network provider is available in the same area, and certain rural and safety-net hospitals. What the complaint alleges. The complaint alleges the policy is an unreasonable restraint on trade under the federal Sherman Act and New York's Donnelly Act. Hospital-dependent surgical specialists cannot practice without access to hospitals and surgery centers, and the practice argues the policy makes Elevance the gatekeeper that decides which physicians get that access. On the complaint's telling, the policy threatens to shut nonparticipating physicians out of facility-based care for commercially insured patients simply because those physicians decline Anthem's reimbursement terms. The suit also brings a common law tortious interference claim and a claim under New York's deceptive business practices law. It asks the court to declare the policy unlawful, to block its implementation, and to award damages. The case is at the complaint stage. The allegations are unproven, and Elevance will have its chance to respond. The No Surprises Act connection. The No Surprises Act sits at the heart of the dispute. Congress built that statute to take patients out of the middle of out-of-network billing fights. Balance billing is prohibited for covered out-of-network services at in-network facilities, and payment disagreements between providers and insurers go to the federal independent dispute resolution process. The complaint argues Elevance's policy works around that framework rather than through it. Before the policy, a nonparticipating physician could treat Anthem members at participating facilities, comply with the balance billing prohibition, and take payment disputes to arbitration. After the policy, the complaint alleges, Anthem can pressure the facility until the facility pressures the physician to join the network or stop treating Anthem members. According to the complaint, Anthem's position is that the arbitration process yields inappropriately high reimbursement rates. The practice answers that arbitration outcomes follow the statutory factors Congress chose. In a statement to Law360, Elevance said the policy is "designed to help protect members from unnecessary out-of-network costs" and addresses what it views as inappropriate use of the dispute resolution process. The insurer said it is aware of the lawsuit and will respond through the legal process. Pushback beyond New York. The New York suit joins a widening response to the policy. The American Hospital Association, the Medical Society of the State of New York, and other provider trade groups have opposed it. The California Hospital Association has brought its own litigation over the 10 percent version, and Indiana has enacted a law barring penalties of this kind. Whatever happens in the Eastern District of New York, the policy is now being contested in courtrooms and statehouses across the country. What the policy does not change. The policy does not touch patient protections. Patients treated by a nonparticipating surgeon at an in-network facility keep the same protections against surprise bills they had before the policy existed. The policy does not remove a physician's ability to take an eligible payment dispute to the federal independent dispute resolution process. Emergency services are exempt. And the penalty lands on the facility's claim rather than on the physician's. Where this leaves your practice. For out-of-network surgeons payer pressure on nonparticipating practice is no longer limited to claim-by-claim payment disputes. Under policies like this one, it can reach the hospitals and surgery centers where surgeons operate. Neurosurgeons, spine surgeons, vascular and cardiothoracic surgeons, and reconstructive plastic surgeons all depend on facility access, and a practice can follow every rule the No Surprises Act sets while its operating relationships get caught up in a payer's network strategy. Watch for a facility asking about your network status during credentialing, bringing up participation when you schedule cases, or adding network language at contract renewal. None of this changes the case for going out of network. It raises the bar on how you do it. The move works when it is planned. You need to know which facilities you depend on, where Anthem sits in each one, which of your disputes will qualify for arbitration, and what the arbitration process will require from your documentation from day one. Minevich Law Group works through that with surgical practices before the move, then handles the arbitration once the claims start flowing. Look at Elevance's own reasoning. The insurer says it needs this policy because arbitration keeps producing payments it would rather not make. That process came from Congress, and the complaint argues its results follow the factors Congress told arbitrators to weigh. Put those two facts together and the policy is a payer's answer to a dispute process that is working for the providers who use it. If you are out of network, that process is yours, and helping surgical practices use it well is what Minevich Law Group does. Minevich Law Group represents out-of-network surgical practices in Federal No Surprises Act arbitration nationwide, along with New York and New Jersey state surprise billing arbitration. If a facility has raised your network status, or you are deciding whether to stay or go out of network, talk to Minevich Law Group before you decide. Call 516-202-2196 or schedule a free consultation.