A provider contract breakdown can affect patients differently depending on their type of health plan. In Virginia, Sentara Health says negotiations with Anthem Blue Cross Blue Shield have ended for Medicare Advantage, Medicaid and Affordable Care Act exchange plans, putting about 96,000 Anthem enrollees at risk of losing in-network access to Sentara providers. The two organizations are still negotiating over commercial, employer-sponsored coverage, so that part of the dispute remains unresolved. The Virginian-Pilot reported the negotiations had continued for nearly a year before Sentara’s October 1 deadline passed.
The reported exposure is not identical across the affected plans. Sentara spokesperson Mike Kafka told InsuranceNewsNet that the 96,000 members include 53,000 Medicaid enrollees, 25,000 Medicare Advantage members and 18,000 marketplace members. The Pilot reported that Medicare Advantage and individual exchange coverage could become out of network with Sentara on January 1, 2027, while the Medicaid cutoff is January 28. Some patients receiving ongoing care, including cancer treatment or obstetric care, may qualify for continuity-of-care protections, the Pilot reported.
Commercial coverage needs to be considered separately: Anthem Virginia president Monica Schmude said it represents 70% of Anthem’s overall business partnership with Sentara, and discussions on those employer-sponsored plans are continuing, according to 13News Now. The Pilot reported that employer-plan members could also face an out-of-network change on January 1 if no agreement is reached. That is a potential consequence of the ongoing talks, not a settled outcome.
The unresolved price dispute
The disagreement combines payment complaints with future reimbursement rates. Sentara alleged that Anthem had more than $105 million in claims payments overdue by at least 90 days, and also accused the insurer of withholding amounts tied to a billing settlement and emergency-department claim reviews, MedCity News reported. Those are Sentara’s allegations; Anthem disputes Sentara’s account of what constitutes fair reimbursement. For the affected Medicare, Medicaid and exchange plans, the Pilot reported that Sentara sought modest increases over a three-year period while Anthem proposed a 4.4% decrease. Anthem’s public-relations director said the insurer’s proposals include quality-related payments and that higher healthcare costs ultimately fall on employers, taxpayers and families, according to the Pilot.
Sentara executive Aubrey Layne Jr. has said the system can no longer absorb what it considers Anthem underpayments. Anthem has said it remains willing to negotiate across its business with Sentara. State Sen. Angelia Williams Graves, a Norfolk Democrat, has urged both sides to return to talks with a counterproposal, the Pilot reported. Sentara has also encouraged members to look for plans that keep their doctors in network and partnered with Chapter to help Medicare patients review coverage options, according to the Pilot.
Why local provider alternatives matter
The potential disruption is playing out in a region where hospital capacity is concentrated among a small number of systems. A Virginia Joint Commission on Health Care presentation reported that Sentara and Riverside Health System together own 65% of Eastern Virginia’s acute-care hospital facilities, 74% of staffed acute-care beds and 80% of acute-care patient days. Those figures describe regional concentration; they do not establish what alternatives any particular Anthem member has or predict the result of the negotiations. CoverVA advises Virginia Medicaid members to check whether their doctors participate in a plan they are considering, because each plan has its own provider network.
Other recent contract disputes show that talks can have different outcomes. In St. Louis, Missouri, BJC HealthCare warned that its Anthem agreement would lapse at the end of 2026 and that services and providers could be out of network starting January 1, 2027, while the sides remained in active negotiations, the St. Louis Post-Dispatch reported. In Oregon, by contrast, OHSU and Regence reached a deal: The Oregonian/OregonLive reported that commercial access would remain in network, while OHSU and Hillsboro Medical Center were still set to leave Regence’s Medicare Advantage and ACA networks on January 1, 2027. These separate disputes illustrate possible contract outcomes, but do not determine how Sentara and Anthem’s negotiations will end.
For Virginia members, the immediate practical task is to verify their particular plan, providers and coverage dates rather than assume that every Anthem-Sentara arrangement is ending at once. The 96,000 figure applies to the plans whose negotiations have failed; the status of commercial talks and any final network changes remain unsettled.
