How could the loss of Anthem's network status affect Sentara Norfolk General Hospital?
Sentara Norfolk General Hospital loses coverage for 25,000 Medicare Advantage members Sentara Norfolk General Hospital will become out of network for Anthem Medicare Advantage members starting January 1, 2027, following the failure of contract negotiations between the two entities. This change affects approximately 25,000 Medicare Advantage members in the region. The dispute arose because Sentara sought a 6.2% blended increase, while Anthem offered about a 1% decrease. While Sentara says it remains in network through at least December 31, 2026, the loss of network status for the new year represents a significant operational and revenue change for the hospital.
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How it reaches Sentara Norfolk General Hospital
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Sentara Health ended contract negotiations with Anthem regarding Medicare Advantage coverage, resulting in Sentara doctors and hospitals becoming out of network for Anthem members starting January 1, 2027. Sentara stated it could no longer absorb Anthem's underpayments, while Anthem disputed that claim. Sentara remains in network for all Anthem members through at least December 31, 2026.
The full event1independent outlet -
The loss of network status means that approximately 25,000 Medicare Advantage members will no longer have in-network access to Sentara Norfolk General Hospital for their care. This requires these members to find alternative providers or plans.
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hospital in Virginia, United States
Everything about Sentara Norfolk General Hospital
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The facts so far
As reported. Each one links to where it comes from.
- Sentara Health doctors and hospitals will be out of network for Anthem Medicare Advantage members starting January 1, 2027.medicaldaily.com
- About 25,000 Medicare Advantage members are affected.medicaldaily.com
- Sentara sought a 6.2% blended increase, while Anthem offered about a 1% decrease.medicaldaily.com
- Sentara says Anthem owes more than $105 million in unpaid claims.medicaldaily.com
Why it matters
For Sentara Norfolk General Hospital, the loss of network status for a major payer like Anthem represents a significant operational and financial risk. The hospital relies on these contracts for revenue, and the loss of coverage for 25,000 Medicare Advantage members could impact its financial stability and patient volume in the region.
This dispute reflects a broader trend in the healthcare market where health systems and insurance providers are struggling to agree on reimbursement rates. Sentara's demand for a 6.2% increase versus Anthem's offer of a 1% decrease highlights the intense pressure on providers to secure adequate payment for services.
What we don't know yet
- Will contract talks between Sentara and Anthem resume?
- How long will patients in active treatment be protected from being out of network?
What would change this answer
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Questions worth asking
Ideas the web ties closely to this story that the explainer doesn't mention. These are prompts for your own research: Brind hasn't answered them.
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About Medigap
How might the broader struggle over reimbursement rates between providers and payers affect patients who rely on Medigap coverage alongside Original Medicare?
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About PPO
Since the dispute involves Medicare Advantage plans, do the specific terms of the network loss differ for members enrolled in PPO versus HMO plans?
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Who else could feel it
Other possible ripples from the same event.
Reporting
- medicaldaily.comOct 7
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Brind's analysis is written by AI from the reporting linked above and can be wrong. This explainer is a possibility worth considering, not a forecast: steps marked as Brind's reasoning are not stated in the reporting. It is not investment advice; do your own research.