Scripps Health & Anthem Negotiation

Updated November 20, 2024

Scripps patients received the latest notification of ongoing negotiation between Anthem Blue Cross and Scripps Health on November 20, 2024. 


We continue to negotiate our contracts in good faith with Anthem Blue Cross, but we still have not reached an agreement. It’s important to know that Scripps is negotiating with Anthem as an advocate for the best interests of our patients and we’re committed to keeping you informed every step of the way. We are working to negotiate fair market-based contracts that keep Scripps in-network for the people and families who depend on us, reduce the impact of Anthem’s unnecessary policies that create delays, burdens, and barriers to patient care, and support our ability to continue providing high-quality care to our community. 


Here, you can find information about: 


  • The ongoing negotiation between Scripps Health and Anthem Blue Cross (now called Elevance) 
  • Why this negotiation is occurring 
  • How it may affect our patients’ ability to access in-network care  
  • How to make your voice heard – ways you can advocate for your own healthcare to preserve in-network access to your trusted Scripps hospitals and doctors 


The current network contracts between Scripps and Anthem are set to expire on December 31, 2024. If Anthem and Scripps do not reach an agreement before January 1, 2025, Scripps hospitals and Scripps doctors will be forced out of network. It’s important to know that some patients, like pregnant patients and those undergoing cancer treatment, will be eligible to apply for Continuity of Care benefits through Anthem for extended in-network coverage with Scripps doctors and hospitals. Find more information in our FAQs. 

Frequently asked questions

Why do 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 health plan pays a hospital or physician for patient care services is called a payment rate, or a 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.

What are Scripps and Anthem negotiating? 

As a not-for-profit health system, Scripps is dedicated to making a positive difference in the health of the patients and communities we serve. However, Anthem has implemented policies that impose administrative burdens on Scripps that make it more difficult for our providers to obtain authorization for patient care. Further, some of Anthem’s policies are preventing Scripps from receiving fair payment for the services that we provide. As part of the negotiations, Scripps is focusing on reducing bureaucratic policies and procedures that Anthem has implemented that impede access to timely and necessary care and that result in making healthcare more expensive.



Additionally, as we expect has happened in your household, we have been impacted by the effects of historic inflation during the past five years. The cost to pay fair salaries to our staff has increased dramatically, while the prices of drugs, supplies and equipment have grown faster than anything we have experienced this century. To address these economic challenges, it is important that Anthem pay Scripps and its doctors fairly for the care and services we provide – without creating barriers to patient care and ensuring timely, accurate payments to our providers.  


Scripps is negotiating in good faith to reach fair and equitable terms with Anthem and has a goal to reach a resolution before December 31, 2024. Should Scripps and Anthem not reach agreement by then, Scripps will be out of network for all Anthem commercial insurance plans starting January 1, 2025. 

When does the current contract with Anthem end?

Should Scripps and Anthem not reach agreement by December 31, 2024, Scripps will be out of network for all Anthem commercial insurance plans starting January 1, 2025.

What types of Anthem health insurance plans are impacted by this negotiation?

All Anthem commercial insurance plans would be impacted if Scripps and Anthem do not reach agreement by January 1, 2025. 

How do I know if my insurance plan is affected? 

Employer sponsored and individual Covered California plans will be impacted.


We encourage patients to call Anthem to learn what the potential impact may be for you based on your specific plan and circumstances.

Which Scripps services and providers are impacted by this negotiation?

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.  

When will the negotiation be resolved?

Our goal is to resolve the negotiation as soon as possible, without any impact to our patients. We hope Anthem will have the same sense of urgency and will collaborate to resolve the negotiation quickly and fairly.

What happens if Anthem doesn’t agree to a fair contract, and Scripps is forced out of network?

If Scripps is forced out of network, Anthem members won’t be able to receive in-network care from Scripps hospitals and physicians. For many patients, this means they will have to pay more out-of-pocket to continue seeing their trusted Scripps physicians and care teams. In some circumstances, Anthem won’t cover any services provided at Scripps (except emergency service).  


Call Anthem at the number on the back of your insurance card to express your concern, and advocate to keep Scripps in-network. We also encourage you to find out if you have out-of-network benefits under your Anthem health plan, and how your out-of-pocket costs may be impacted if you receive out-of-network services at Scripps after January 1, 2025. If you receive insurance through your employer, talk to Human Resources. Let them know that you would like to discuss your options to preserve in-network access to the high-quality care and unmatched expertise from Scripps’ doctors and renowned specialists.

What if I have a medical emergency on or after January 1, 2025?

You will always have access to emergency care, regardless of network status. If you or a loved one are experiencing a medical emergency, please go to the location nearest you immediately. Anthem will determine coverage and patient responsibility for emergency care based on the services provided. .  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 care on or after January 1, 2025?

Potentially 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 if Scripps is 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


Apply for Continuity of Care through Anthem. Anthem will review applications and determine eligibility on a case-by-case basis. Call Anthem at the number on the back of your insurance card to learn more.  

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

For now, nothing has changed. Patients should continue scheduling and keeping appointments with their Scripps physicians and hospitals. If an agreement is not reached by December 31, 2024, contact Anthem to verify out-of-network benefits before scheduling appointments on or after January 1, 2025, to ensure you understand how your costs may change, so that you can make the best decision for you regarding your care.

What can I do to protect my in-network access to my Scripps Health Doctors?

If you want to keep Scripps and Scripps doctors in your insurance network, we encourage you to: 


  • If you receive insurance through your employer, talk to Human Resources. Let them know that you would like to discuss your options to preserve in-network access to the high-quality care and unmatched expertise from Scripps’ doctors and renowned specialists.
  • Call or email Anthem. We understand you likely have questions about what this potential change to your healthcare network might mean, and how it may impact your out-of-pocket costs and access to your trusted Scripps doctors. Call the number on the back of your insurance card to connect with Anthem and learn more about how this may affect you and your family.

Is Blue Cross or Blue Shield impacted?

If the termination occurs, Scripps will no longer participate in the networks that are sponsored or administered by Anthem, and you will not be able to receive in-network care at Scripps. Please note that Anthem has used several names over the years, including “Anthem, Inc.”, “Anthem Blue Cross” and “Elevance.” After January 1, 205, Scripps will be out-of-network for any health plan operated under one of these names. Please also 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 identification card or reach out to Human Resources if you receive insurance through your employer to learn what the potential impact may be for you based on your specific plan and circumstances.

How can I stay up to date on the Scripps Health/Anthem negotiation?

For more information on the progress of the negotiation, please continue to visit this page, and be sure to read emails and any other communications from Scripps Health for important updates.