VA. — Sentara Health said on Monday it is ending negotiations with Anthem Blue Cross Blue Shield for patients under Medicare Advantage, Medicaid and ACA Exchange over reimbursement costs. Anthem says they still want to negotiate all lines of business with Sentara.
Sentara said it proposed a 6.2% blended rate increase for 2027, while Anthem countered with a 1% rate decrease. About 215,000 Anthem members in Hampton Roads will be affected with the end of these negotiations.
Sentara said that it has been working with Anthem for over a year to negotiate contract extensions. The company sent a letter to Anthem on Sept. 23 setting an Oct. 1 deadline to accept their Medicare, Medicaid and Exchange proposal, which Sentara said Anthem did not accept. Negotiations continue for commercial, employer-sponsored plans.
"Anthem would not agree to Sentara's modest proposal for Medicare Advantage, Medicaid, and ACA Exchange products," Sentara wrote in a release sent to News 3. "Instead, Anthem repeatedly proposed to decrease reimbursement for the majority of these plans."
Watch previous coverage: Sentara, Anthem contract dispute could affect 215,000 Hampton Roads members
Sentara ended negotiations for these plans in response and are now preparing to transition affected patients onto new plans. Sentara Executive Vice President and Chief Administrative Officer Aubrey Layne said they cannot continue handling Anthem's underpayments.
"Preparing now, and being transparent about it, gives our patients the time and information they need to make the right choice for themselves and their families," Layne said. "Our focus is on supporting affected patients to navigate this transition, while continuing to work to reach a fair agreement on our remaining commercial plans."
Monica Schmude, president of Anthem Blue Cross and Blue Shield of Virginia, previously told News 3 that Anthem wants Sentara to remain in its network.
“We want Sentara to remain in our network, and I want to make that very, very clear,” Schmude said.
Schmude said Anthem recently submitted two proposals in an effort to reach a long-term agreement, but she said Sentara has not moved from its previous proposal.
For employer-sponsored and individual health plans, Anthem said Sentara is seeking 30% price increases over three years, or roughly 10% annually.
Schmude said employers are already facing financial pressures and may not be able to absorb increases of that size.
"Sentara argues that health plans should absorb the impact of changes in government healthcare funding, while at the same time asking Anthem for higher reimbursement across those government programs and increases of as much as 30% for employer-sponsored coverage. These costs ultimately have to be paid by employers, taxpayers, and families," Anthem said in a statement to News 3.
Watch previous coverage: Sentara, Anthem remain at odds over rates as contract deadline approaches for Virginia members
Anthem said they still want to negotiate on all lines of business with Sentara, not just commercial plans.
"Anthem remains ready to negotiate with Sentara across all lines of business, including Medicare Advantage, Medicaid, Individual, and Commercial," Anthem said. "We have repeatedly put forward proposals that fairly reimburse Sentara, recognize legitimate cost pressures, and provide opportunities for millions more in reimbursement tied to quality and improved patient outcomes. Instead, Sentara ended negotiations on Medicare Advantage, Medicaid, and Individual plans after Anthem did not agree to demands that would require millions more in reimbursement than Sentara receives today.”
Sentara claimed that Anthem has failed to meet financial obligations, amounting to hundreds of millions of dollars, and the company canceled all remaining meetings in the year dedicated to resolving claim-related matters.
"I wish this were just about just financial, but there are some other actions that that Anthem has taken to try to get us to negotiate to their way," Layne said in a previous interview with News 3. "One is they have more than $105 million in charges for unpaid claims that are more than 90 days overdue, so they have slowed their payments to us."
Sentara said that all Anthem members can continue to see their Sentara care providers until Dec. 31, and patients who qualify under continuity-of-care protections like active cancer treatments or obstetrics care, will keep in-network access even further into 2027.
Anthem agreed that "nothing changes for members today," saying that Sentara still has access to Anthem's standard claims, dispute and appeal processes. Anthem says they are also preparing Continuity of Care support for eligible members.
Sentara said patients should try and find a health plan that allows them to keep seeing their Sentara care teams in network. Sentara says members with questions can click here for more info.
Anthem said that this suggestion is a concern as Sentara is offering their own health plan, which could come at a higher cost for Anthem members.
"Virginians deserve healthcare they can afford and meaningful choices in the marketplace. Our responsibility is to protect both," Anthem said.
