VIRGINIA — Sentara Health and Anthem Blue Cross and Blue Shield of Virginia remain at odds over reimbursement rates, with the current contract between the two health care companies set to expire at the end of 2026.
The dispute could affect 215,000 Anthem members in Hampton Roads who receive care from Sentara providers across Virginia.
Sentara proposed a 6.2% blended rate increase for 2027, while Anthem has proposed a 1% rate decrease, according to Sentara leaders back in July.
See previous coverage: Sentara, Anthem contract dispute could affect 215,000 Hampton Roads members
Monica Schmude, president of Anthem Blue Cross and Blue Shield of Virginia, told News 3 on Monday 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.
“In most cases, we don't see employers giving wage increases at 10% year over year, unfortunately,” Schmude said. “And so to ask for this egregious amount is not something that, as I represent employers, specifically self-funded employers, that they can really afford.”
Sentara disputes Anthem’s characterization of its proposal.
In a statement, Sentara said it is seeking a “modest 6.2% annual increase across our plans” because of rising health care costs.
Sentara also said Anthem has delayed processing $105 million in care that Sentara has already provided to patients. Sentara said Anthem recently canceled Joint Operational Committee meetings scheduled for the rest of the year and asked Anthem to reinstate them to address outstanding claims issues.
Schmude disputed the characterization of Anthem’s claims payments, saying Anthem continues to pay Sentara and other health systems as part of its regular business operations.
“We are a significant partner in payment to Sentara, as we are for many health systems throughout the Commonwealth,” Schmude said. “We continue to work with all health systems as a matter of regular practice.”
The two companies also disagree over the proposed rates for government and individual insurance plans.
Sentara said its proposal includes a 6.2% increase across its relationship with Anthem, while Anthem said Sentara’s proposed increases vary by line of business.
According to Anthem, Sentara’s 2027 Virginia individual-market filing calls for an increase of about 22%, compared with about 12% for Anthem’s plan, based on Virginia State Corporation Commission rate-filing materials.
Sentara said the 30% figure cited by Anthem applies only to its commercial business and compounds rate changes over multiple years. Sentara said its 6.2% proposal is a single-year blended adjustment across its plans.
For Medicare Advantage, Medicaid and individual coverage, Sentara has set an Oct. 1 deadline for Anthem to accept its proposed rates or, according to Anthem, Sentara could stop negotiations on those plans.
Anthem emphasized that Oct. 1 is a negotiating deadline, not a network exit date.
Nothing changes for Anthem members immediately.
If the companies do not reach an agreement before the current contract expires Dec. 31, 2026, Anthem members could face higher out-of-pocket costs or lose in-network access to Sentara providers, depending on their plan.
