REGION — Scripps Health patients whose care has been covered by Anthem Blue Cross are considered out of network as of Wednesday, following months of unsuccessful negotiations between the two companies.
Scripps Health and Anthem Blue Cross have been in contract renewal discussions since early 2024 and warned customers in October that Scripps may no longer be in-network if the two parties couldn’t agree.
The deadline passed at midnight on Jan. 1 with no agreement, leaving around 125,000 people with Anthem insurance no longer able to access in-network prices through one of San Diego County’s largest medical providers.
In a statement, Scripps officials said they attempted to negotiate with Anthem to remove bureaucratic “red tape,” requiring significant time and resources from doctors and staff to navigate.
“During the negotiation, Scripps was advocating to reduce Anthem’s bureaucratic policies and procedures to improve our patients’ experiences and outcomes and help keep costs down,” Scripps said. “Ultimately, Anthem did not choose to prioritize our patients – their insurance customers – and did not agree to create a new, fair contract that would have allowed families with Anthem coverage to continue to see their trusted Scripps doctors at the locations they’re used to visiting as part of their network.”
Anthem, in its own statement, pointed the finger at Scripps Health. The insurance provider said they offered “reasonable, above-inflation payment increases” to reimburse medical providers, but Scripps wanted to significantly increase prices charged to patients covered by Anthem health plans.
“Agreeing to these demands by Scripps would create a significant financial burden for local families and businesses. These higher costs would lead to substantially higher out-of-pocket costs, deductibles, and copayments for our members and impact local employers and small businesses as well,” Anthem said.
While some patients had been preparing for this moment since October, many were stunned.
Cassandra Rae Escobar, 24, of San Diego, sees a gastroenterologist and endocrinologist through Scripps for her Crohn’s disease and will no longer have this care covered by Anthem. She said she never learned about the contract issues until mid-December when her endocrinologist mentioned it during an appointment.
Now, it is too late to sign up for other insurance, and she doesn’t know when she can fill her prescriptions again.
“I have lost two doctors who healed me. I’m now scared. I don’t know what to do or think. If I had known earlier that this was going to be an issue, I would have never signed onto an insurance plan that was having these issues,” Escobar said.
Some patients are losing coverage options for the second time in the past year. On New Year’s Day of 2024, two major Scripps medical groups ceased accepting Medicare Advantage plans from carriers, including Anthem Blue Cross, Blue Shield of California, and several others.
This change affected around 32,000 San Diego County seniors.
Anthem policyholders currently receiving ongoing care through Scripps may be able to continue paying in-network costs under Anthem’s Continuity of Care program, but they must apply for consideration.
Continuity of Care may apply to patients hospitalized at the time that the hospital goes out of network, pregnancy, care of a newborn child between birth and 36 months, terminal illness, or surgery or procedure authorized by the health plan and scheduled within 180 days of the provider going out of network.
Scripps noted that the changes taking effect Tuesday do not impact Blue Shield of California policyholders, as this is a different entity than Anthem.
Scripps also stated that Anthem policyholders can still come into a Scripps emergency department, as emergency visits must be covered as in-network.
Patients can find more information and resources online at scripps.org/anthem.
Scripps has five main hospital campuses in San Diego, Chula Vista, La Jolla and Encinitas and dozens of clinics and urgent care sites, with specialty care in cancer, cardiology, orthopedics, gynecology and more.
