Lowering Healthcare Cost Trends in Virginia
What You Need to Know About Our Talks With Sentara Health
Sentara has notified Anthem that many of its hospitals, physicians, and other care providers will leave our network if we do not reach a new agreement before the current contracts expire.
The good news is that nothing changes today. You can continue seeing your Sentara doctors and hospitals while negotiations continue. If you have an issue with scheduling an appointment due to network participation, please contact Member Services at the number on your ID card for assistance. Sentara is not out of network at this time.
We believe members should never have to choose between access and affordability in healthcare. 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 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.
- Anthem’s network also includes every other major hospital system in the Tidewater and Northern Virginia regions, giving you many affordable, in-network alternatives.
If Sentara Leaves Anthem’s Network, What Could Change and When?
Key Dates:
- Today: No changes. You can continue seeing your Sentara providers.
- December 31, 2026:
- Medicare Advantage agreements for physicians and facilities are scheduled to expire, if no agreement is reached.
- Employer-based and individual (ACA) health plan agreements for physicians and facilities (subject to exclusions) are scheduled to expire, if no agreement is reached.
- January 27, 2027: Medicaid agreements for physicians and facilities are scheduled to expire, if no agreement is reached.
To understand how healthcare contract negotiations work, check out this short video.
This is About How Much More You’ll Pay for Healthcare
Our responsibility is to 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 increases are about three times higher than wage growth or the general inflation rate. That means higher copayments, deductibles, and insurance premiums.
We have proposed payment rates that fairly reimburse Sentara while helping protect members and employers from unreasonable increases in healthcare costs.
We’re also concerned that Sentara executives do not want to follow industry standard claim reviews that protect patients and employers from overbilling. Exempting Sentara could lead to incorrect or inflated bills for care that may lead to higher out-of-pocket costs for our members.
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 – discussing the proposals, 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, Reasonable Costs for Our Members
To keep care accessible for our members, we have offered Sentara payment rates that:
- Align with rates in place at other similar Virginia hospitals.
- Protect patients and employers from being overcharged.
- Pay Sentara fairly.
- Support continued access to high-quality care while helping keep healthcare affordable.
We have also proposed quality-based incentives that would allow Sentara to earn increased reimbursement 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
These negotiations are happening at a time when 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.