Sentara Health and Anthem Dispute Over Payment Rates in Hampton Roads
What happened
Sentara Health and Anthem Blue Cross Blue Shield of Virginia are engaged in a financial dispute regarding payment rates. Sentara Health insists Anthem increase payments by 6.2%, while Anthem has requested a 1% reduction. If no agreement is reached, Sentara Health has notified Anthem that most contracts will expire at year's end.
From pilotonline.com
Why it matters
The contract expiration could leave over 200,000 Anthem-insured residents in Hampton Roads out of network for Sentara Health services. For non-emergency care, Anthem’s HealthKeepers HMO might deny claims entirely, requiring patients to pay the full sticker price instead of the negotiated rate.
From pilotonline.com
Who's involved
- AnthemInsurance company involved in the payment rate dispute with Sentara Health
- Sentara Heart HospitalHealthcare organization involved in the payment rate dispute
- Sentara Norfolk General HospitalHospital involved in the payment rate dispute
Who could feel it
Possible knock-on effectsThese are possibilities Brind reasoned out, not predictions, and not advice. Most are not stated in any report.
- Sentara Norfolk General HospitalSpeculative
Sentara Norfolk General Hospital might face reduced revenue due to contract expiration and insufficient reimbursement.
- Sentara Heart HospitalSpeculative
Sentara Heart Hospital might face reduced revenue due to contract expiration and insufficient reimbursement.
- AnthemSpeculative
Anthem might face increased costs related to network instability and claim denials.
Keep exploring
The entities involved
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Medicare
US federal health insurance
Related events
- Medicare payments are reported not to cover care costs in Oregon.
- Galvani and Fitzpatrick co-authored a study finding that Medicare-level payments reduce healthcare costs.
- Backing legislation to strengthen Medicare payments.
- Medicare programs are credited for driving down costs through the implementation of price caps and programs.
- A healthcare bill concerning Medicare reimbursement is awaiting action in the House leadership.