Scripps Health informed over 125,000 patients that its contract with Anthem Blue Cross could expire on January 1, 2025, if negotiations for a fair deal fall through. Without an agreement by December 31, Scripps hospitals and doctors would leave Anthem’s provider network, leaving patients to pay out-of-network rates to see their doctors. Exceptions would exist for patients undergoing treatment under “continuity of care” provisions.
This standoff mirrors other recent healthcare disputes. For instance, contract talks between Anthem and the University of California health system in 2023 extended beyond their December 31 deadline before concluding in February. Similarly, North Carolina’s Duke Health and UnitedHealthcare are approaching an October 31 deadline, facing hurdles over approvals and appeals that slow care.
Approval and reimbursement issues are also at the core of Scripps’ concerns. Richard Neale, Scripps’ chief growth officer, disclosed that Anthem denied 2,300 claims last year totaling $34 million, of which only $6.5 million was recovered on appeal. Scripps ended up covering $27.5 million in unpaid services. Neale said that Anthem’s sudden reversals on pre-approval for procedures have complicated matters further.
Rising costs intensify the impasse. Between 2021 and 2024, Scripps’ compensation costs rose 8% annually, while pharmaceutical expenses surged by 14%. A new state wage law will add $20 million to Scripps’ payroll.
Anthem responded that it is committed to finding an agreement that ensures affordable care access for its members. Nathan Kaufman, a local healthcare consultant who received one of the letters, noted that top medical providers like Scripps increasingly feel pressured to insist on improved contracts. However, he remains optimistic that a resolution will be reached, even as patients are caught in the middle.