Anthem Blue Cross Negotiations with Scripps Health: Scripps Has Chosen to Leave Our San Diego Care Provider Network

 

Our members are our priority. We know this is especially concerning for our members currently receiving care at Scripps and we are here to help. If you were receiving treatment for a serious or complex condition prior to January 1, 2025, 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 if you are receiving certain types of care.

 

We have coordinated with our other San Diego care provider network partners to ensure our members have access to high quality care at other health facilities, including UC San Diego Health, Sharp HealthCare, Palomar Medical Center and others. Our network includes hundreds of other physicians, specialists, and ancillary care providers in the San Diego area. Members may call our service center at the number on the back of their ID card for assistance finding alternative in-network care providers.

 

Here’s Why This Happened
For months, we’ve been working in good faith with Scripps to keep their doctors and hospitals in our network. Already one of the most expensive health systems in California, Scripps continues to seek to significantly increase the prices they charge patients covered by Anthem health plans. As just one example, Scripps is already reimbursed more than ten times what Medicare reimburses for a routine emergency room visit. Despite these already-inflated costs, Scripps continues to demand price increases at rates two times higher than trend benchmarks set by the State of California Office of Health Care Affordability (OCHA).

 

These higher costs would lead to substantially higher out-of-pocket costs, deductibles, and copayments for our members. The price hikes would impact local employers and small businesses as well. Over 96% of Anthem’s payments to Scripps are for members who are covered by employers that pay directly for their employees’ health care bills. This means that our community’s 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 and Sustainable
We firmly believe our care providers should be reimbursed fairly, and that is reflected in our offers to Scripps during these negotiations. Anthem has offered reasonable, above-inflation payment increases that keep health care affordable for our members. Our offers, which are consistent with payment increases in place with other California health systems, also align with the State of California’s new spending targets, and more than cover the cost of providing quality care at their facilities.

 

We have also offered opportunities for Scripps to earn millions of dollars in additional revenue through quality-of-care incentives.
 

 

We continue to work collaboratively with other hospital systems and doctors to improve health outcomes and moderate cost trends in California. Health care providers and health plans working together is crucial to building a better, more affordable health system. In fact, we’ve recently entered into new multi-year contract agreements with some of the state’s largest systems like Sutter Health System; Dignity Health System, Providence Health System, and many others.

 

Reining in skyrocketing prices charged for care is a first step in any serious effort to relieve the pressure that soaring health care costs place on individuals and working families. We are asking Scripps Health to work with us before prices become unsustainable, not just for working families and their employers, but for California’s health care system overall.

Negotiations Continue
We continue to work in good faith to negotiate a new agreement for Scripps to remain in our network that includes reasonable payment increases that fairly compensate Scripps for the care they provide while also keeping care accessible and affordable for those we serve in San Diego County.

 

 

What should I do if I need emergency care from Scripps?
Emergency services are not affected. Members should always call 9-1-1 or go to the nearest emergency room in a life-threatening situation, even if that emergency room is not in our network. Coverage will be provided according to the member’s policy benefits and in-network cost shares.

 

Yes, some Anthem HMO members can continue to go to their Scripps Health doctors until February 2. These members have been notified and can call the member services number on their Anthem member ID card for more information.

 

Anthem understands the importance of timely access to care. If a service is not available at an alternate participating provider, members may request an out-of-network referral by contacting Customer Service. Requests will be reviewed on a case-by-case basis pursuant to Anthem’s Out-Of-Network Referral Policy. When an out-of-network referral is approved by Anthem, the member’s in-network benefit levels will apply. However, because Scripps is no longer in Anthem’s provider network as of January 1, 2025, members may be responsible for higher out-of-pocket expenses, depending on their benefit plan. Every effort will be made to assist members in understanding the potential financial consequences of the decision to seek services from a non-participating provider.