Sentara Health has formally notified Anthem Blue Cross and Blue Shield of Virginia that it intends to allow certain commercial, Medicare and Medicaid agreements to expire if the parties cannot reach new contract terms. According to Sentara, the dispute could potentially affect nearly 380,000 Anthem members in Virginia. The health system framed the move as the result of protracted negotiations and unresolved payment issues.
Under the current sequence of contract expirations, nothing changes for members immediately. Sentara remains in-network under existing agreements through at least Dec. 31 for some commercial and Medicare members, and through Jan. 28, 2027, for Medicaid enrollees. Additional contracts are scheduled to lapse on a rolling basis later in 2027 if no new deals are struck.
Sentara stated that approximately 43,000 Anthem members could be out of network as of Jan. 1 for specific contracts that end on that date. Of the nearly 380,000 potentially affected across all contracts, about 62,000 are Anthem Medicaid members whose current contract is effective through Jan. 28, 2027.
Sentara said it sought a 6.2% annual reimbursement increase across the affected Anthem contracts. Anthem reportedly proposed reducing rates by roughly 1% instead. Sentara characterized the insurer’s proposed reduction as deepening an existing reimbursement gap that does not cover the cost of delivering care.
Beyond rate negotiations, Sentara alleges the insurer has not met timely payment obligations. The health system claims Anthem owes more than $105 million in billed charges tied to claims more than 90 days overdue. Sentara also stated Anthem had not paid $12 million related to a 2025 billing settlement and had withheld roughly $4 million by downgrading the severity of emergency department visits.
Anthem denied Sentara’s allegations regarding late or downgraded payments. In its statement, the insurer said its Virginia plan pays approximately 97% of claims within 14 days and 99% within 30 days. Anthem added that claims taking longer than 30 days generally are undergoing review or reconciliation or require additional information.
The insurer also expressed disappointment that Sentara made details of the negotiations public, and said it remained focused on reaching an agreement that preserves access to care while keeping it affordable.
The dispute follows more than eight months of direct negotiations between the Virginia health system and the insurer. Sentara’s notification to Anthem is part of a broader pattern of increasingly public, contentious contract negotiations between hospitals and insurers since 2022. Rising labor and administrative costs have driven providers to seek higher reimbursement, while insurers aim to control medical spending.
The article places the Sentara–Anthem disagreement alongside other high‑profile disputes that moved beyond threat stage. Examples cited include Mount Sinai’s exit from Anthem’s network after failed talks, which affected about 200,000 patients, and contract breakdowns between Johns Hopkins and UnitedHealthcare that left roughly 60,000 enrollees out of network. These cases illustrate how protracted negotiations can threaten patient access and prompt public scrutiny.
For now, members covered under the existing Sentara–Anthem agreements continue to have in‑network access through the stated contract end dates. The timing and scale of any access disruption will depend on whether the parties reach new terms before particular contracts expire. The public notice signals a willingness by Sentara to let contracts lapse rather than accept terms it views as financially unsustainable.
Both sides have framed the dispute differently: Sentara highlights reimbursement shortfalls and alleged unpaid claims; Anthem emphasizes high claims‑payment rates and the need to manage costs. Future developments will depend on continued negotiations, potential interim settlements, or unilateral contract expirations on scheduled dates.
If some contracts do lapse, affected Anthem members could face out‑of‑network care at Sentara facilities, with implications for patient cost sharing and network access. Payer–provider contract disruptions can also shift care patterns, create administrative burdens for patients and clinicians, and influence local market dynamics.
Because both parties continue to negotiate and maintain portions of their agreements in force through late 2026 and into January 2027, the immediate clinical impact is limited. However, the case underscores ongoing tensions between hospitals and insurers over reimbursement levels, claims processing and the financial sustainability of provider operations.
Further details about negotiation progress, any interim resolutions, or the specific contracts that may expire on particular dates were not reported beyond the timeframes and figures cited above. The situation warrants monitoring for updates that would affect patient access or payer networks.