Elevance Health is putting its foot down on a growing billing loophole: hospitals charging premium in-facility rates for care delivered at off-campus clinics and doctor's offices. Starting across 2026 and 2027, the insurer — which covers roughly 45 million members — will require providers to identify the exact location where services were rendered, then cross-check that data against hospital addresses to ensure off-campus care is reimbursed at lower, site-appropriate rates.

The move targets a well-documented pattern in which hospital-owned outpatient departments bill at hospital rates even when care is delivered miles away from the main campus. Research shows hospital outpatient departments can charge up to 13.5 times more than standalone physician offices for the same service — a gap that inflates costs for both insurers and patients. Elevance's new policies apply to its commercial, Medicare Advantage, and Medicaid plans.

By the Numbers:

• Hospital outpatient departments can charge up to 13.5x more than independent physician offices for the same service
• Medicare spent an extra $2.7 billion over three years on just four services billed at hospital outpatient rates instead of physician office rates (BCBS Association, 2023)
• Patient out-of-pocket costs were $411 million higher as a result

Why it matters: Elevance's policy is part of a broader industry shift toward site-neutral payments — a model that pays the same rate for the same service regardless of who owns the building. With Congress and CMS also pushing in this direction, this could meaningfully lower costs for patients and employers, though hospital groups warn it may reduce access to care at convenient outpatient locations.