Elevance Health has announced new billing policies that require hospitals to specify where patient care was actually delivered. The insurer says it will cross-check those locations against hospital addresses and pay lower rates for services performed at off-campus outpatient departments and labs. The goal is to stop hospitals from charging higher facility-based rates for care delivered outside the main hospital campus.
The policies apply to Elevance's commercial, Medicare Advantage, and Medicaid plans and will take effect over 2026 and 2027. Elevance, which serves about 45 million members, says the change will improve billing transparency and make care more affordable. Research cited by the insurer shows hospital-owned outpatient departments can charge up to 13.5 times more than independent physician offices for the same services.
The American Hospital Association opposes the move, arguing that the reimbursement cuts could force hospitals to reduce or eliminate services at convenient off-campus locations. The AHA says higher rates reflect hospitals' unique costs, including 24/7 operations, overhead, and the obligation to treat all patients regardless of ability to pay.
Elevance's approach aligns with broader policy momentum toward site-neutral payments. Lawmakers included new reporting requirements for off-campus hospital departments in a February spending package, and CMS has proposed site-neutral Medicare payments for imaging and drug administration. Elevance's policy is a private-sector step in the same direction, though the AHA warns it may come at the expense of patient access.