Sentara begins transition planning for affected patients as Anthem fails to accept fair and reasonable agreement on Medicare Advantage, Medicaid and ACA Exchange plans

Anthem continued to propose decreases in reimbursement; negotiations for Commercial, employer-sponsored plans continue.

Sentara Health, Virginia's leading not-for-profit integrated healthcare system, today announced the end of negotiations with Anthem Blue Cross Blue Shield of Virginia on Medicare Advantage, Medicaid, and ACA Exchange plans after Anthem failed to accept the fair, sustainable proposal put forth by Sentara. Negotiations on commercial (employer-sponsored) plans will remain active for a period of time.

For nearly a year, Sentara has been working to negotiate contract extensions with Anthem for its various insurance lines reflective of the true cost of delivering high-quality care. Anthem would not agree to Sentara's modest proposal for Medicare Advantage, Medicaid, and ACA Exchange products. Instead, Anthem repeatedly proposed to decrease reimbursement for the majority of these plans. Sentara sent a letter to Anthem on September 23 that set an October 1, 2026, deadline for Anthem to accept our Medicare, Medicaid, and Exchange proposal. Anthem did not accept our proposal by the deadline.

As such, negotiations have ceased for these plans and Sentara is preparing for affected Medicare Advantage and ACA Exchange out-of-network status effective January 1, 2027, and for affected Medicaid out-of-network status effective January 28, 2027.

"We are disappointed that we could not reach an agreement with Anthem on Medicare Advantage, Medicaid, and Exchange, however, we can no longer absorb their underpayments," said Aubrey L. Layne, Jr., Executive Vice President and Chief Administrative Officer for Sentara Health.

"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. 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," Layne added.

What patients need to know

Right now, all Anthem members can continue to see their Sentara care providers, as nothing changes today. Sentara remains in-network for Anthem members through at least December 31, 2026, and patients who qualify under continuity-of-care protections, including those in active cancer treatment or obstetrics care, will retain in-network access even further into 2027.

Since August, Sentara has repeatedly asked Anthem to simultaneously discuss continuity of care planning to no avail. Coordination on continuity of care is essential for some of the most vulnerable and ill patients to ensure their complex and/or chronic conditions can be seamlessly managed. Sentara is committed to continuing to provide care to Anthem members and guiding them through Anthem's continuity of care process as much as possible.

Additionally, Sentara is actively negotiating contracts with additional payors and has begun the process of supporting affected Anthem members in understanding their coverage options. As open enrollment season approaches, patients are encouraged to find a health plan that allows them to keep seeing their Sentara doctors and care teams in network. Upcoming open enrollment dates include:

• Medicare Advantage: October 15 - December 7, 2026
• Exchange: November 1, 2026 - January 15, 2027
• Medicaid (Charlottesville/Western Halifax): August 19 - October 31, 2026
• Medicaid (SW Virginia): December 19, 2026 - February 28, 2027

Sentara has partnered with Chapter, a licensed Medicare advisory service that can help patients compare available Medicare plans, clarify eligibility and enrollment rules, and guide patients through choosing the right coverage. It is free of charge for those qualified for Medicare Advantage. Patients can visit askchapter.org/sentara or call 1-855-531-2355.

Anthem members with questions can visit www.sentara.com/KeepSentara for more information and the latest updates.

Anthem continues to ignore unresolved financial obligations

In addition to rate negotiations for 2027 and beyond, Sentara is managing a series of unresolved financial issues in which Anthem has failed to meet its obligations. Anthem continues to delay payment on the more than $105 million they already owe Sentara for care that has already provided to its patients who are Anthem members. In addition, Anthem has refused to pay $27 million following a 2025 billing settlement and withheld $49.7 million by systematically downgrading the severity of emergency department visits - in effect, paying Sentara for a lower level of care than Anthem patients actually received.

On the same day that Anthem issued its September 28 press release providing an update on negotiations, it also canceled all meetings for the remainder of the year that are dedicated to resolving claim-related matters, like these outstanding claims payment issues.

"The lack of urgency around resolving these outstanding claims, combined with the cancelation of meetings designed to discuss issues like this, continues to illustrate Anthem's priority on their bottom line rather than properly reimbursing providers for the care provided to Anthem members," said Layne.

Commercial negotiations continue; Anthem commits to passing increases on to employer groups

In addition to refusing to discuss continuity-of-care planning for patients, continuing to delay payment on the money owed Sentara and canceling the regular meetings designed to resolve claim-related matters, Anthem submitted an early termination notice for their Individual Product Transplant program for Commercial members and terminated its Blue Distinction certifications for all Sentara hospitals. The Blue Distinction program has no impact on reimbursement or referrals and serves as a marketing tool.

"Every decision we've made throughout this process has been guided by one question: what's best for the patients and families who count on us for care," said Layne. "The rest of the United States healthcare system is absorbing the impacts of H.R.1. and Anthem needs to participate also. If they want to pass higher rates on to their employers instead of absorbing some of it, that's their decision, but they can't blame hospitals when their quarterly earnings continue to climb."