Scripps Health & Anthem Negotiation

Updated December 18, 2024

Scripps sent its patients a notification regarding the status of the ongoing negotiation between Anthem Blue Cross and Scripps Health on December 18, 2024.  


Scripps Health has been working hard since early summer to keep Scripps doctors and hospitals in-network with Anthem Blue Cross. Anthem’s current policies create delays, burdens and barriers to patients and their families receiving necessary care. It’s time for Anthem to do their part and prioritize our patients’ healthcare needs. We continue to ask to remove these and other challenges to accessing care. 


Anthem will force Scripps out-of-network starting January 1, 2025 if Anthem is unwilling to agree to fair terms that prioritize patient care. We share your concern and disappointment as we recognize the reality of the situation. This is not an outcome we want. We plan to continue to fight for our patients and remove stress from accessing healthcare. 


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  
  •   Continuity of Care coverage and the application process 
  • Please know that some patients, like pregnant patients and those undergoing a course of treatment like 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 below.  
  • 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 


We continue to advocate for you. Thank you for trusting us to care for you and your family. 

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. 

Anthem Blue Cross infographic assists patients in understanding if this negotiation will impact them.

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 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 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, under the current agreement between Anthem and Scripps, Anthem has implemented policies that cause unnecessary delays, burdens, and barriers to patient care. 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. 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 continuing to negotiate in good faith to reach fair and equitable terms with Anthem and has a goal to reach a resolution before December 31, 2024. Should Anthem force Scripps out of network because Anthem and Scripps have not reached agreement by then, Scripps will be out of network for all Anthem commercial insurance plans starting January 1, 2025. 

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 are negotiating to ensure that our Anthem patients have access to care without undue barriers and allow our doctors and staff to continue their focus on caring for patients and serving our community.

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.


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 negotiation may affect 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 impacted by this negotiation?

All Anthem commercial insurance plans and individual Covered California plans would be impacted if Scripps and Anthem do not reach agreement by December 31, 2024.  


We encourage patients to call Anthem to learn what the potential impact may be for you based on your specific plan and circumstances. Anthem can also help you apply for Continuity of Care coverage if you think you might qualify. 

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. 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. 

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.  


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 negotiation 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. 

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.  


However, it’s possible that Anthem will force Scripps out of network starting January 1, 2025 for all Anthem commercial insurance plans. This is not an outcome we want, and we share your disappointment if this happens. 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 negotiation may affect you and your family.  

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 your Human Resources department to understand what options are available. Let them know that you would like to preserve in-network access to the high-quality care and unmatched expertise from Scripps’ doctors and specialists. 


Additionally, Anthem is legally required to offer extended, in-network benefits coverage for certain patients to continue receiving care at Scripps. 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 as soon as possible. The application can be downloaded here. Anthem is responsible for determining which patients qualify, and will make those determinations 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.  

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 emergency room 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. Call Anthem at the number on the back of your insurance card to learn more. 

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 


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. 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.  

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?

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.  


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.  
  • Understand that you may have to pay as a self-pay patient. Anthem will then reimburse you for the money spent based on your out-of-network benefits and you can sign the check from Anthem over to Scripps as payment for services.  


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 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. 

I have an Anthem HMO plan, why was I assigned a new Primary Care Physician instead of my Scripps Health doctor?

If you have an Anthem HMO plan, Anthem has informed us that they will be sending out new insurance cards at the end of December. These cards may list a new primary care physician (PCP) that differs from your current Scripps PCP. We understand how important your relationship with your PCP is and this change was not initiated by Scripps.  


If Scripps and Anthem are able to agree to the terms of a new agreement, you will be able to call Anthem and ask to be re-assigned back to your Scripps PCP. Anthem has informed us they will not re-assign you to your current Scripps PCP unless you call Anthem. However, you will only be able to be re-assigned back to your current Scripps PCP if Anthem and Scripps agree to the terms of a new agreement.  

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:  


  •   Talk to Your Employer. If you receive insurance through your employer, talk to your Human Resources department to understand what options are available. Let them know that you would like to keep in-network access to high-quality care and unmatched expertise from Scripps’ doctors and 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 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, 2025, 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 insurance card or reach out to your employer’s Human Resources if you receive insurance through your employer to learn what the potential impact may be on you based on your specific plan and circumstances.

I have Traditional Medicare or Medicare Supplement plan, am I possibly affected by this?

Patients with Traditional Medicare or a Medicare Supplement plan are not impacted by this negotiation. 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 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. You can also call 1-800-SCRIPPS Monday through Friday 7 am - 7 pm PT with any questions. To advocate to keep Scripps in-network and amend Anthem’s harmful policies, call Anthem at the number on your insurance card.