VIRGINIA — Sentara announced Monday that it is ending negotiations with Anthem Blue Cross Blue Shield over coverage for Medicaid, Medicare and Affordable Care Act exchange patients, raising questions for Anthem customers who rely on Sentara providers.
About 215,000 Anthem customers in Hampton Roads could face higher out-of-network costs if the two companies do not reach an agreement.
Scot Stratton of Norfolk has Anthem coverage through his employer. He and his wife use his Anthem plan and see Sentara doctors.
Stratton said his cardiac issues and sleep apnea make the possibility of changing doctors especially concerning.
“We're going to end up putting out extra money for out of pocket because we're out of network. And with so many doctors that I have tied to my account, it's like I would be at a loss. I'd have to start over with new doctors,” Stratton said.
Sentara said in a Monday press release that Anthem repeatedly proposed lower reimbursement rates for the majority of the Medicaid, Medicare and ACA exchange plans involved in the negotiations.
See previous coverage: Sentara ends negotiations with Anthem for Medicare, Medicaid, ACA patients
“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,” Aubrey Layne Jr., executive vice president and chief administrative officer for Sentara Health, wrote in the press release. “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.”
Anthem Blue Cross Blue Shield of Virginia President Monica Schmude said Sentara's announcement came during open enrollment and included an option for Anthem customers to choose a Sentara Health Plan.
“On that list is the Sentara health plan. So let's be clear about that. Sentara is not only a health system, but they also are a competitor to Anthem in all of those what we call lines of business,” Schmude said.
Schmude said she understands why customers may be concerned about the ongoing negotiations.
“We want to make sure that we have, you know, continuity of care, that we continue to have not only an affordable network available, but make access available as well," Schmude said. "We don't want to interrupt care that's being delivered today or care decisions that should be made today and in the new year.”
See previous coverage: Sentara, Anthem remain at odds over rates as contract deadline approaches for Virginia members
Stratton said he has not started looking for backup insurance but expects finding new doctors could mean traveling farther for care.
“I'd have to go to Suffolk or whatnot just to get healthcare, which would be really more inconvenient,” Stratton said.
Anthem members can continue to see their Sentara care providers through at least Dec. 31, 2026, while the dispute continues.
After WTKR's Naomi Washington interviewed Anthem Tuesday, Sentara sent News 3 a statement.
“Sentara is working to ensure anyone impacted is covered by insurance and has shared every option in the recent release.”
Anthem said it still wants to negotiate with Sentara across all lines of business.
