The Facts About Anthem Blue Cross’ Negotiations with Scripps Health
December 23, 2024Scripps Health has notified Anthem Blue Cross that it will leave our network on January 1, 2025, unless we agree to allow them to drastically increase the price they charge patients covered by Anthem health plans.
Anthem has been working hard for many months to negotiate to keep Scripps in our network and we remain optimistic an agreement will be reached—but we can’t agree to the extreme price increases Scripps is currently demanding – increases that would lead to significantly higher out-of-pocket costs, deductibles, and copayments for our health plan members.
At Anthem, we are always working to ensure access to high-quality affordable healthcare while streamlining and enhancing the patient and provider experience as much as possible. We believe that our members deserve better, and we will not stop advocating on their behalf.
What’s Happening?
Our current contract with Scripps Health is set to end on January 1, 2025. This contract sets the prices Scripps charges employers and its patients covered by Anthem health plans.
Anthem and Scripps are currently working to reach agreement on a new contract to keep them in our local care network after January 1, 2025. Unfortunately, Scripps is seeking higher-than-market increases which are simply unsustainable and would lead to local consumers paying significantly more for their health care through higher out-of-pocket costs, deductibles and copayments. In fact Scripps, already one of the most expensive health systems in California, is now demanding to increase prices by more than three times the statewide health care spending targets set by the State of California Office of Health Care Affordability (OCHA).
How Scripps’ price increases would impact your costs in just three years:
Our current contract with Scripps Health is set to end on January 1, 2025. This contract sets the prices Scripps charges employers and its patients covered by Anthem health plans.
Anthem and Scripps are currently working to reach agreement on a new contract to keep them in our local care network after January 1, 2025. Unfortunately, Scripps is seeking higher-than-market increases which are simply unsustainable and would lead to local consumers paying significantly more for their health care through higher out-of-pocket costs, deductibles and copayments. In fact Scripps, already one of the most expensive health systems in California, is now demanding to increase prices by more than three times the statewide health care spending targets set by the State of California Office of Health Care Affordability (OCHA).
How Scripps’ price increases would impact your costs in just three years:
- $2,800 more for an ER visit
- $17,000 more for a hip joint replacement
- $104,500 more for open heart surgery
These higher costs would hit employers hard as well. More than 80% of Anthem members in California are covered by employers who directly pay their employees’ healthcare bills. That means that these local employers would feel the full burden of these price increases – hampering their ability to raise pay, offer benefits, and hire new workers.
Our Offer: Fair Payment Increases That Keep Care Affordable
Anthem has offered reasonable, above-inflation payment increases that keep healthcare affordable for our members. Our offer is in line with payment increases in place with other California health systems. Our offers also align with the State of California’s new spending targets, and more than cover the cost of providing quality care at their facilities. And we’ve offered opportunities for Scripps to earn millions of dollars in additional revenue through quality-of-care incentives.
To date, Scripps has refused these offers.
Negotiations Continue
We continue to work in good faith to negotiate reasonable payment increases that fairly compensate Scripps for the care they provide while also keeping care accessible and affordable in San Diego County. We will not stop advocating for the members and employers we serve, in line with our commitment to simplifying healthcare through quality solutions that meets individuals’ unique needs.
As a long-time trusted health partner, serving Californians for the past 86 years, we remain committed to continuing in-network access to Scripps facilities and doctors at rates that are affordable and sustainable for the consumers and employers we serve.
Our Offer: Fair Payment Increases That Keep Care Affordable
Anthem has offered reasonable, above-inflation payment increases that keep healthcare affordable for our members. Our offer is in line with payment increases in place with other California health systems. Our offers also align with the State of California’s new spending targets, and more than cover the cost of providing quality care at their facilities. And we’ve offered opportunities for Scripps to earn millions of dollars in additional revenue through quality-of-care incentives.
To date, Scripps has refused these offers.
Negotiations Continue
We continue to work in good faith to negotiate reasonable payment increases that fairly compensate Scripps for the care they provide while also keeping care accessible and affordable in San Diego County. We will not stop advocating for the members and employers we serve, in line with our commitment to simplifying healthcare through quality solutions that meets individuals’ unique needs.
As a long-time trusted health partner, serving Californians for the past 86 years, we remain committed to continuing in-network access to Scripps facilities and doctors at rates that are affordable and sustainable for the consumers and employers we serve.
Frequently Asked Questions
What happens if a new agreement is not reached with Scripps by January 1, 2025?
Our commitment stands firm to establish a new agreement, and we remain optimistic about our shared dedication to this objective. In an event where an agreement is unfortunately not reached, Scripps doctors and facilities will be out-of-network for Anthem members effective January 1, 2025. This could affect the out-of-pocket obligations for Anthem members who receive non-emergency care at Scripps. We can assure our members that we have a substantial network of high-quality partners throughout San Diego County prepared to provide care for members currently under Scripps including UC San Diego Health, Sharp HealthCare, Palomar Medical Center and others.
What do I need to do right now?
Scripps remains in our network until at least January 1, 2025, and we are working to keep them in the network well beyond that date. We remain optimistic an agreement will be reached. Please continue to check this website for updates.
What if I’m being treated at Scripps and they leave Anthem’s network?
We know this is especially concerning for our members currently receiving care at Scripps. That’s why we’re taking steps to help in the event Scripps leaves our network. If you are receiving treatment for a serious or complex condition that will continue past December 31, 2024, please contact our Member Service Center at the number on your Anthem ID card. You may be able to continue your care at Scripps for a limited time after that date if you are receiving certain types of care.
What should I do if I need emergency medical care from Scripps?
Even if Scripps leaves our network on January 1, 2025, members should always call 9-1-1 or go to the nearest emergency room in a life-threatening situation. Coverage will be provided according to the member’s policy benefits and in-network cost shares.
Where can I go for information and updates?
We will update this website as negotiations continue. Anthem members may also login to the Sydney Health app or anthem.com/ca/ or call the Member Service Center at the number on their ID card for help finding alternative doctors and hospitals.
Our commitment stands firm to establish a new agreement, and we remain optimistic about our shared dedication to this objective. In an event where an agreement is unfortunately not reached, Scripps doctors and facilities will be out-of-network for Anthem members effective January 1, 2025. This could affect the out-of-pocket obligations for Anthem members who receive non-emergency care at Scripps. We can assure our members that we have a substantial network of high-quality partners throughout San Diego County prepared to provide care for members currently under Scripps including UC San Diego Health, Sharp HealthCare, Palomar Medical Center and others.
What do I need to do right now?
Scripps remains in our network until at least January 1, 2025, and we are working to keep them in the network well beyond that date. We remain optimistic an agreement will be reached. Please continue to check this website for updates.
What if I’m being treated at Scripps and they leave Anthem’s network?
We know this is especially concerning for our members currently receiving care at Scripps. That’s why we’re taking steps to help in the event Scripps leaves our network. If you are receiving treatment for a serious or complex condition that will continue past December 31, 2024, please contact our Member Service Center at the number on your Anthem ID card. You may be able to continue your care at Scripps for a limited time after that date if you are receiving certain types of care.
What should I do if I need emergency medical care from Scripps?
Even if Scripps leaves our network on January 1, 2025, members should always call 9-1-1 or go to the nearest emergency room in a life-threatening situation. Coverage will be provided according to the member’s policy benefits and in-network cost shares.
Where can I go for information and updates?
We will update this website as negotiations continue. Anthem members may also login to the Sydney Health app or anthem.com/ca/ or call the Member Service Center at the number on their ID card for help finding alternative doctors and hospitals.
