Understanding Elevance Health's New Site-of-Care Billing Policies

Elevance Health will implement a series of billing policies in 2026 and 2027 designed to address increasingly common situations where care provided at an off-campus location is billed at a higher hospital rate. Dr. Catherine Gaffigan, president of Health Solutions at Elevance Health, explains how these policies can support more accurate payments and help lower the cost of care.
 

What specifically is Elevance Health changing?

The policies are designed to give us clearer information about where care is actually delivered and help ensure services are paid at the appropriate rate. Among the changes, hospitals will be required to identify the physical location where care was provided, and certain services delivered at off-campus hospital locations will be reimbursed at the applicable off-campus rate. We are also taking steps to prevent higher hospital billing for certain lab tests performed elsewhere.
 

What’s driving this announcement?

Care delivery organizations across the country often provide care in multiple settings in addition to a hospital location. Increasingly, we see care taking place at an off-campus location that is billed at a higher hospital rate. When care is delivered at an off-campus location, reimbursement should reflect the setting where that care was actually provided. We’ve seen the impact this can have firsthand. In one case, a member experienced a medical bill that was more than 10 times the normal amount because of this type of billing practice. That’s why having accurate information about where care was delivered matters. The Blue Cross Blue Shield Association noted that Medicare paid an additional $2.7 billion and patients paid $411 million more out of pocket over three years when certain services were delivered in hospital outpatient settings rather than physician offices, where those services could have been appropriately provided. As an advocate for our members and the plan sponsors we serve, we believe these policies can help lower the cost of care.

Employers have an important stake in this issue as they work to manage healthcare spending and provide affordable benefits for their employees. Greater billing transparency gives health payers the ability to ensure care is being reimbursed accurately.

What does this mean for members?

For members, this is fundamentally about greater transparency and more accurate payment. When we have better information about where care was delivered, we can more accurately determine the appropriate payment for that service. Over time, efforts like these can help address unnecessary spending and help lower the cost of care for the people and organizations we serve.
 

What kinds of healthcare services can be affected by these billing practices?

These billing practices can affect a variety of outpatient services delivered across different care settings. The issue is not limited to one specialty or type of care. As more care is delivered in outpatient settings, it becomes more important to ensure providers are paid accurately for the care being delivered to our members.

Currently, the same service performed at a hospital or an off-campus location may be reimbursed differently. Having accurate information about the location of care helps us determine the appropriate payment for that service. In a complex healthcare system, health plans play an important role in helping members access high-quality care while also helping lower costs for members and plan sponsors. Improving site-of-care transparency and supporting more accurate payment is one way we can advance both goals.
 

What are some additional ways to rein in this kind of billing?

Greater transparency about where care is delivered is an important step. We’re encouraged by the growing attention policymakers at both the federal and state levels are giving to site-of-care transparency and appropriate payment. Continued efforts to ensure billing accurately reflects where services are provided can help patients, employers, and health plans better understand and manage healthcare costs.
 

Why is Elevance Health taking this action now?

This isn't a new issue, but it has become more important as more care is delivered in outpatient settings and outside traditional hospital campuses. At the same time, employers, consumers, and policymakers are placing greater emphasis on healthcare affordability and transparency. We see growing momentum at both the federal and state levels to improve transparency around where care is delivered and how it is billed. For example, states including Indiana and Maine have strengthened billing requirements for off-campus care, while new federal transparency requirements for certain off-campus hospital services are scheduled to take effect in 2028. As a health plan, we have an important role in using that information to help ensure healthcare services are paid appropriately and help lower the cost of care for the people and organizations we serve.

The broader cost environment makes this work particularly important. According to federal data, U.S. spending on hospital care reached approximately $1.6 trillion in 2024 and accounted for 31% of total U.S. healthcare spending. Finding ways to ensure services are paid appropriately is an important part of addressing those rising costs.
 

Will these policy updates affect member access to care?

These policies are focused on billing and reimbursement and are designed to improve transparency about where care is delivered. Our goal is to ensure payment appropriately reflects where services are delivered while maintaining our focus on quality and access.

Frequently Asked Questions

What are Elevance Health’s new policies designed to address?

Elevance Health’s new policies are designed to address situations where care provided at an off-campus location is billed at a higher hospital rate. The policies will provide clearer information about where care is actually delivered, and certain services delivered at off-campus hospital locations will be reimbursed at the applicable off-campus rate. They also include steps to prevent higher hospital billing for certain lab tests performed elsewhere.

Why does the location where care is delivered matter for healthcare costs?

The location where care is delivered matters for healthcare costs because the same service may be reimbursed differently depending on the setting and resources used. Increasingly, care delivered at an off-campus location may be billed at a higher hospital rate. Having accurate information about where care was delivered helps determine the appropriate payment and, over time, can help reduce unnecessary healthcare spending and lower the cost of care.

What kinds of healthcare services can be affected by these billing practices?

The healthcare services affected by these billing practices can include a variety of outpatient services delivered across different care settings. The issue is not limited to one specialty or type of care. As more care is delivered in outpatient settings, accurate information about the location of care becomes increasingly important in determining appropriate payment.

When are these new policies taking effect?

Elevance Health will implement these billing policies in 2026 and 2027. The changes come as more care is delivered in outpatient settings and outside traditional hospital campuses, and as employers, consumers, and policymakers are placing greater emphasis on healthcare affordability and transparency. The policies will help Elevance Health use clearer information about where care is delivered to support more accurate payment and help lower the cost of care for the people and organizations we serve.