Lowering Healthcare Costs in Virginia
What You Need to Know About Our Talks With Sentara Health
Sentara has notified Anthem that it intends to leave our network beginning January 1, 2027, unless we reach a new agreement.
The good news is that nothing changes today. You can continue seeing your Sentara doctors and hospitals while negotiations continue.
We believe members should never have to choose between access to quality healthcare and affordable coverage. Every agreement we negotiate is intended to protect both.
Virginia families deserve access to high-quality care, affordable coverage, and meaningful choice. Those principles guide every provider negotiation we conduct.
We're Protecting Your Access to Care
- We remain committed to working collaboratively with Sentara to reach an agreement before any disruption occurs.
- Sentara remains in our network until at least January 1, 2027, for members in our Medicare and Commercial plans, including employer sponsored health plans. Sentara will remain in-network for our Medicaid members until at least January 27, 2027. You may continue seeing your Sentara doctor or specialist as you have in the past at this time.
- If Sentara leaves our network and you’re in active treatment there, you may be able to continue your care at Sentara for a limited time if you are receiving certain types of care. Our Member Services team will be ready to help you continue your care or transition to another provider.
- For emergency care, coverage will be provided according to your policy benefits and applicable cost shares.
- Anthem’s network also includes every other major hospital system in Tidewater and all other Virginia regions, giving you many affordable, in-network alternatives.
To understand how healthcare contract negotiations work,
check out this short video.
This is About How Much More You’ll Pay for Healthcare
We negotiate on behalf of the members, employers, and taxpayers who ultimately pay for healthcare. Every provider contract must balance fair reimbursement with keeping healthcare affordable.
Sentara is seeking to increase the prices it charges employer-sponsored health plans by as much as 30% over the next three years. Every additional dollar paid for healthcare ultimately affects premiums, deductibles, out-of-pocket costs, and employer healthcare expenses. That's why we have a responsibility to carefully evaluate requests of this magnitude while continuing to work toward an agreement that protects both access to care and affordability.
Sentara’s 30% price increase would be about three times higher than wage growth or the general inflation rate. That would mean higher copayments, deductibles, and insurance premiums.
We have proposed payment rates that fairly reimburse Sentara while helping protect members and employers from unnecessary healthcare cost increases.
We’re also concerned that Sentara executives want to strip away industry standard claim reviews that protect patients and employers from overbilling. Exempting Sentara from these standard reviews could lead to incorrect or inflated bills for care.
Here’s What’s Happening
Health plans and hospitals routinely negotiate contracts like this. These agreements determine provider reimbursement, quality incentives, and the cost of healthcare for members and employers.
While Sentara has chosen to discuss these negotiations publicly, our focus remains on the work that matters most – sitting down at the table, working through our differences, and reaching an agreement that protects access to care while keeping healthcare affordable.
We want Sentara to remain in our network, and negotiations continue.
What We're Doing
- Continuing to negotiate with Sentara.
- Working to keep Sentara in our network.
- Preparing continuity-of-care support, if needed.
- Keeping members informed throughout the process.
- Protecting access to care while helping keep healthcare affordable.
Our Proposal: Fair Payment Rates for Sentara, Lower Costs for Our Members
To lower healthcare costs for our members, we have offered Sentara payment rates that:
- Align with payment rates in place at similar Virginia hospital systems.
- Protect patients and employers from being overcharged.
- Pay Sentara fairly.
- Support continued access to high-quality care while helping lower healthcare cost trends.
- We have also proposed quality-based incentives that would allow Sentara to earn millions more by improving patient care outcomes.
We Want to Keep Sentara in Our Network
So far, Sentara executives have not accepted our proposals or our requests to meet with them. We continue to work toward a new agreement, and we hope to reach one before any care disruption for our members.
If Sentara ultimately decides to leave our network, Anthem will work directly with affected members to help them continue care, understand their options, and minimize disruption.
- We will work directly with members receiving treatment for serious or complex conditions to help them continue care with their current provider until they finish treatment.
- Anthem members will still have access to a broad care provider network, including every other major health system in the Tidewater region. Our teams will assist members in transitioning to another in-network care provider.
Why We’re Fighting for Your Healthcare Affordability
Healthcare costs are already putting immense pressure on families and employers.
- Nearly half of U.S. adults struggle to afford healthcare, and 1 in 4 delay necessary care due to cost (KFF).
- Employers face the same challenge. More than 70% of Virginia employers pay healthcare claims directly—so a sudden jump in hospital costs would drastically and directly increase expenses for small and large employers. That can limit wage growth, hiring, and investment.
Every additional dollar spent on healthcare is ultimately paid by Virginia families, employers, and taxpayers. That's why we believe protecting access to care and affordability must go hand in hand.