Lowering Healthcare Cost Trends in Virginia
What You Need to Know About Our Talks With Sentara Health
Anthem Continues Working Toward a Solution
Anthem wants Sentara to remain in our network, and we continue working toward agreements that protect access to high-quality care while keeping healthcare affordable for Virginia families and employers.
We recently submitted two additional proposals to Sentara designed to reach an agreement through compromise and collaboration. Our proposals provide fair reimbursement and opportunities for Sentara to earn additional reimbursement by improving quality and patient outcomes. Sentara has refused these offers, continuing to demand a 30% price increase for patients covered by employer-based health plans.
Sentara's latest written response did not move from its previous proposal.
Anthem remains ready to negotiate.
Nothing changes for members today.
Sentara remains in Anthem's network. You should continue seeing your Sentara doctors, specialists, and hospitals as you normally would.
If you have difficulty scheduling an appointment because you've been told Sentara is already out of Anthem's network, contact Member Services using the number on your member ID card.
We're Protecting Your Access to Care
- We remain committed to working directly with Sentara to reach an agreement before any disruption occurs.
- If an agreement is not reached, the Sentara physicians, specialists, and hospitals identified in the grid below would no longer participate in Anthem’s Commercial and Medicare Advantage networks beginning January 1, 2027.
- Sentara will remain in-network for our Medicaid members until at least January 27, 2027.
- You should continue seeing your Sentara doctor or specialist as you normally would while negotiations continue.
- 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.
- Our network also includes every other major hospital system in the Tidewater and Northern Virginia regions, giving you many affordable, in-network alternatives.
To understand how healthcare contract negotiations work, check out this short video.
For everyone
Continue receiving care as you normally would.
Sentara is still in our network until at least January 1, and we remain hopeful that Sentara will join us in working to make healthcare more accessible and affordable for our community.
If you have difficulty scheduling an appointment because you've been told Sentara is already out of Anthem's network, contact Member Services using the number on your member ID card.
If Sentara Leaves Anthem’s Network, What Could Change and When?
Key Dates:
- Today: No changes. You can continue seeing your Sentara providers.
- October 1, 2026: This is a negotiating deadline established by Sentara for Medicare Advantage, Medicaid and Individual health plans. It is not a network exit date.
- December 31, 2026: If we’re unable to reach a new agreement, Sentara physicians and facilities (subject to exclusions) will leave our Medicare Advantage, employer-based, and individual (ACA) care provider network.
- January 27, 2027: Medicaid agreements for physicians and facilities are scheduled to expire, if no agreement is reached.
Why We’re Fighting for Your Healthcare Affordability
Our responsibility is to negotiate on behalf of the members, employers, and taxpayers who pay for healthcare. Every provider agreement must balance fair reimbursement with healthcare affordability.
For employer-sponsored coverage, Sentara wants to increase prices by 30% over the next three years. Those costs don't disappear. They can ultimately affect:
- Patient out-of-pocket costs like copayments, deductibles, and other out-of-pocket costs.
- Employee paycheck contributions for health insurance.
- Employer healthcare spending.
- Premiums for individual (ACA) plans
Healthcare prices can't keep growing dramatically faster than the paychecks and employer budgets that have to support them.
That's why Anthem has a responsibility to carefully evaluate increases of this magnitude while continuing to work toward an agreement.
There is a responsible path forward
Our proposals:
- Provide fair reimbursement.
- Align payment rates with other similar Virginia health systems.
- Support continued access to high-quality care.
- Recognize financial pressures facing healthcare providers.
- Create opportunities for Sentara to earn additional reimbursement through improved quality and patient outcomes.
- Protect employers and members from unsustainable healthcare cost increases.
- Preparing for every scenario while continuing to pursue agreements.
We have continued putting solutions forward because our goal is an agreement.
What We Are Doing Now
We are:
- Continuing to put forward solutions.
- Remaining ready to negotiate.
- Working to protect access for Medicare Advantage, Medicaid, and Individual members.
- Preparing Continuity of Care support if needed.
- Working with other network providers to support appointment availability.
- Keeping members, employers, brokers, and communities informed.
- Helping protect healthcare affordability.
Sentara Is Both a Healthcare Provider and a Health Insurer - Why That Matters
There is another important part of this healthcare market that Virginians should understand.
Sentara doesn't only operate hospitals, physician practices and other healthcare facilities. It also operates Sentara Health Plans, which competes for employers and members in Virginia.
We believe Virginians benefit from strong competition and meaningful choices among both healthcare providers and health plans.
When one organization dominates healthcare delivery and also competes as a health insurer in the same market, questions about its effect on healthcare prices, competition, and consumer choice deserve careful consideration.
Our goal is to preserve access to high-quality care, healthcare affordability and meaningful choices for Virginians.