Scripps Health & Anthem Negotiation

Updated January 1, 2025

After many months of negotiating in good faith, Scripps Health is now out-of-network with Anthem Blue Cross, effective January 1, 2025. Please know this is not the outcome we wanted. We did everything we could to avoid this situation while advocating strongly for our Anthem patients’ and the community’s best interests.

It’s also important to know that you are always welcome at Scripps Health, regardless of what health insurance plan you have or whether you have network coverage. Emergency care is always considered in-network and is not impacted by this change. If you or a loved one are experiencing a medical emergency, please go to the emergency department location nearest you.

We are here to help you determine the best next steps for you and your family’s access to care. Below, you can find information about:

How the contract termination may impact your coverage and out-of-pocket costs
Who to contact to learn about changes to your specific insurance plan and how that will impact your access to Scripps Health doctors and hospitals
How to apply for Continuity of Care

Frequently asked questions

When did the contract with Anthem end?

As of January 1, 2025, Scripps is out-of-network for all Anthem commercial insurance plans and Covered California plans.

We encourage you to call the number on the back of your insurance card to connect with Anthem to learn how the contract termination affects coverage and out-of-pocket costs for you and your family. Anthem can also help you apply for Continuity of Care coverage if you think you might qualify.

What types of Anthem health insurance plans are considered out-of-network as a result of the contract termination?

All Anthem commercial insurance plans and Covered California plans are impacted as of January 1, 2025.

We encourage patients to call Anthem to learn what this means for your specific coverage and out-of-pocket costs based on your benefits. Anthem can also help you apply for Continuity of Care coverage if you think you might qualify.

Patients with Traditional Medicare or a Medicare Supplement plan are not impacted. If you have coverage through Traditional Medicare or a Medicare Supplement plan, you can continue to visit your Scripps hospitals and physicians as you normally would.

How do I know if my insurance plan is affected?

Anthem employer-sponsored and Covered California plans are impacted.

We encourage patients to call Anthem to learn what the impact means for you based on your specific plan and circumstances. Anthem is legally required to offer extended, in-network benefits coverage for certain patients, like those who are pregnant or receiving cancer treatment, under Continuity of Care coverage. Contact Anthem to learn more and to apply for Continuity of Care coverage.

Patients with Traditional Medicare or a Medicare Supplement plan are not impacted. If you have coverage through Traditional Medicare or a Medicare Supplement plan, you can continue to visit your Scripps hospitals and physicians as you normally would.

Is Blue Cross or Blue Shield impacted?

Anthem has used several names over the years, including “Anthem, Inc.”, “Anthem Blue Cross” and “Elevance.” As of January 1, 2025, Scripps is out-of-network for any health plan operated under one of these names. Please note that Blue Shield of California is a separate company from Anthem. Scripps participates in Blue Shield’s networks and will continue to be in-network for those networks after January 1, 2025. Please call the number on the back of your insurance card or reach out to your employer’s Human Resources department if you receive insurance through your employer to learn how your coverage is impacted, based on your specific plan and circumstances.

Now that Scripps Health is out-of-network with Anthem, can I still see my Scripps doctors or go to a Scripps Emergency Room?

Yes. As a healthcare system committed to serving our community, it’s important to know that you are always welcome at Scripps Health. However, being out-of-network means that for most care, with the exception of emergency care, you may have to pay higher out-of-pocket costs to access Scripps doctors and hospitals. Some patients will no longer have coverage for all appointment types with Scripps doctors and hospitals, so it’s important that you contact Anthem before receiving care to help ensure you understand how your benefits and costs have changed. You’re also welcome to call us. We are here to help you determine the best next steps for you and your family’s access to care.

Regardless of what health insurance plan you have or whether you have coverage, emergency care is always considered in-network and is not impacted by this change. If you or a loved one are experiencing a medical emergency, please go to the emergency department location nearest you.

Which Scripps services and providers are impacted by this termination?

All Scripps services and providers would be impacted, although please remember that if a patient has a medical emergency, they should go to the nearest emergency room. Health plans like Anthem are required to cover emergency services provided at any hospital’s emergency department, including those that are not in the health plan’s network.

We encourage you to call the number on the back of your insurance card to connect with Anthem to voice your concerns and learn more about how this termination may affect you and your family. Anthem is legally required to offer extended, in-network benefits coverage for patients with certain medical conditions, like those who are pregnant or are under a course of treatment like receiving cancer treatment, under Continuity of Care coverage. Contact Anthem to learn more and to apply for Continuity of Care coverage.

What if I have a medical emergency — can I still go to a Scripps Emergency Department?

Yes. You will always have access to emergency care, regardless of network status. If you or a loved one is experiencing a medical emergency, please go to the emergency department location nearest you immediately. Health plans like Anthem are required to cover emergency services provided at any hospital’s emergency department, including those that are not in the health plan’s network.

What if I’m pregnant or receiving complex treatment or critical care for a chronic illness that requires on-going care?

Losing in-network access to your physicians and hospitals is always concerning, and particularly so for pregnant or chronically ill patients. Anthem is required by state and federal law to allow patients with certain medical conditions to continue seeing their current care team at in-network rates for a certain period of time, even though Scripps has been forced out-of-network. This is referred to as “Continuity of Care.” The types of conditions for which patients are entitled to seek Continuity of Care include the following:

Patients who are hospitalized at the time that the hospital goes out-of-network
A serious chronic condition
Pregnancy
Care of a newborn child between birth and age 36 months
Terminal illness
A surgery or other procedure that is authorized by the health plan and scheduled to occur within 180 days of the provider going out-of-network

If you think you may qualify for Continuity of Care benefits, we encourage you to apply for Continuity of Care through Anthem as soon as possible. You can find the application here. Anthem will review applications and determine eligibility on a case-by-case basis. If you have any further questions regarding Continuity of Care through Anthem Blue Cross or the application process, please contact Anthem by calling the number on the back of your insurance card.

Why did Scripps and Anthem have a contract?

When a healthcare provider like a hospital or physician group agrees to accept the HMO, PPO, and other plans that a health plan offers, the provider becomes a participant in the health plan’s “network.” Both parties sign a contract and agree to several things that regulate how the organizations will work together. The contract includes things like the amount the health plan will pay the provider for services that the provider gives to patients who are covered by their plans, and rules for when and if the health plan can:

Require patients and physicians to get approval from the health plan before receiving physician-prescribed care, or the health plan will not pay for the visit(s), test(s) or procedure(s) (this is called “pre-authorization”)
Deny paying a portion of, or all of, the patient’s hospital or provider’s services for a variety of reason (denials), despite the fact that a physician ordered the care

After caring for a patient, the hospital/physician bills each patient’s health plan for services, and the health plan applies its coverage criteria for the health care services. If the health plan approves the coverage for services, the health plan is expected to pay the hospital or physician for the patient’s care based on the agreed-upon rates in the contract. The amount that a health plan pays a hospital or physician for patient care services is called a “payment” or “reimbursement” rate.

If the health plan does not approve the patient’s health care services, the health plan will deny the provider’s request for payment and try to justify this by saying that the patient should have received preauthorization, or for some other reason.

There are many other details and regulations that apply to a hospital/physician’s and health plan’s contract. Reimbursement rates, denials and pre-authorizations are the most common things that are negotiated by health plans and providers.

What were Scripps and Anthem negotiating?

Under the previous contract agreement between Anthem and Scripps, Anthem had implemented policies that were causing unnecessary delays, burdens, and barriers to patient care. Anthem’s policies forced Scripps doctors and staff to spend significant time and resources navigating the insurance company’s red tape. Time and resources should be focused on caring for patients. 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. As a not-for-profit health system, we are dedicated to making a positive difference in the health of the patients and communities we serve. Our goal throughout the negotiation was to do the right thing for our patients.

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. We are disappointed by this outcome, despite our steadfast patient advocacy.

How do Anthem’s policies impact patients?

Anthem’s policies force Scripps doctors and staff to spend significant time and resources navigating the insurance company’s red tape. Time and resources should be focused on caring for patients. The many Anthem patients and their families who have unfortunately experienced the effects of Anthem’s policies are aware of the added stress and impact an insurance company’s bureaucratic policies can have — particularly during those anxious times when someone is navigating a new diagnosis or treatment. We believe that patients should have access to care without undue barriers.

How do I apply for Continuity of Care benefits?

If you believe you may qualify for Continuity of Care benefits, we encourage you to download the application and submit it to Anthem as soon as possible. If needed, work with your Scripps care team to complete the application. Anthem will review applications and determine eligibility on a case-by-case basis. For more information, call Anthem using the phone number on the back of your insurance card.

Anthem is legally required to offer extended, in-network benefits coverage for certain patients. The types of conditions for which patients are entitled to seek Continuity of Care include the following:

Patients who are hospitalized at the time that the hospital goes out-of-network
A serious chronic condition
Pregnancy
Care of a newborn child between birth and age 36 months
Terminal illness
A surgery or other procedure that is authorized by the health plan and scheduled to occur within 180 days of the provider going out-of-network

Should patients with Anthem insurance reschedule existing appointments or stop scheduling future appointments?

You, your family, and everyone in our community is always welcome at Scripps. However, it is important to contact Anthem to understand how the contract termination impacts your coverage and may increase your out-of-pocket costs, so that you can make the best decision for you regarding your care.

Below you may find basic information about how some plans may be impacted. However, we strongly encourage you to contact Anthem to learn how your coverage and costs may change. Learning about your specific plan’s coverage from Anthem is the best way to ensure you understand what it means to visit Scripps now that the system is no longer in-network.

For PPO patients looking to schedule appointments on or after January 1, 2025:

Request an Assignment of Benefits (AOB) from Anthem. This document allows Anthem to pay Scripps directly. However, please be aware that you may still be considered a self-pay patient and be reimbursed by Anthem afterward.

For HMO patients looking to schedule appointments on or after January 1, 2025:

You will have to pay the full cost of care if you choose to receive non-emergency services at Scripps and would be treated as a self-pay patient.
You may be required to pay a portion of the estimated charges at the time of care.

What other insurance plans does Scripps Health accept?

Scripps accepts several other health insurance plans. You can view our list of in-network health insurance plans.

Who can I contact with questions? Can I change insurance plans to a plan that includes Scripps in-network?

• Talk to your employer to understand what options are available. Some employers offer a second insurance option that includes Scripps.

• Call Anthem at the number on the back of your insurance card to learn how your costs and access to care (outside of the emergency department) will be impacted based on your specific benefits plan.

You can also call 1-800-SCRIPPS Monday through Friday, 7 am - 7 pm PT with any questions. We want to ensure you have the information you need to continue getting the care you need.

I get my prescriptions from a Scripps pharmacy. Am I impacted by the termination?

Patients who receive their prescriptions at a Scripps pharmacy are not impacted by the termination and can continue to receive their prescriptions from a Scripps pharmacy as you normally would.

My Scripps physician prescribes my medication. Can I still get a refill at my pharmacy?

Any refills that are already prescribed can be filled at your pharmacy. If you need a new refill, you will need to contact your provider office to determine if a refill can be granted.

I get my prescriptions through the Scripps mail order pharmacy. Am I impacted by the termination?