A reimbursement battle between Sentara Health and Anthem Blue Cross and Blue Shield of Virginia could affect healthcare access for nearly 380,000 Virginians next year if the two sides fail to reach a new contract. The dispute covers commercial Medicare and Medicaid agreements, but patients remain in-network for now while negotiations continue.
The biggest gap is over money. Sentara is asking for an average 6.2% increase in reimbursement rates for 2027, citing higher labor, medication and supply expenses and anticipated reductions in federal healthcare funding. Anthem, by contrast, has proposed an average 1% decrease, creating a difference of more than seven percentage points between the two positions.
The potential impact is particularly significant in Hampton Roads, where Sentara says approximately 215,000 Anthem members could be affected. If Sentara ultimately leaves Anthem’s network, emergency care would generally remain protected by federal surprise-billing rules, but people seeking routine or non-emergency treatment could face fewer in-network choices or substantially higher out-of-network costs, depending on their health plan.
The dispute also highlights a larger question facing the U.S. healthcare system: how much hospitals should be paid and who ultimately absorbs higher reimbursement costs. Georgetown health policy researcher Sabrina Corlette noted that if insurers agree to substantially higher hospital rates, those expenses can eventually show up elsewhere through higher premiums, deductibles or changes to employer health benefits.
Sentara’s financial position is also becoming part of the debate. Federal cost-report data reviewed by Corlette shows Sentara Norfolk General Hospital reported a 29.5% profit margin in 2024, compared with a national hospital median of about 14%. Sentara, meanwhile, says Anthem owes more than $105 million in claims that have remained unpaid for over 90 days, plus another $12 million connected to a previous billing settlement.
For Anthem members, the immediate message is that nothing changes yet. Both companies say negotiations are continuing, but patients who depend on Sentara hospitals or physicians should pay particular attention to their plan’s 2027 network information during open enrollment. A failure to reach an agreement could force some patients to reconsider where they receive care—or pay considerably more to remain with their existing providers.
