Scripps Health & Anthem Negotiation

After many months of negotiations, Scripps and Anthem Blue Cross have agreed to an extension of our current contracts. This means that while negotiations will continue on a sustainable, long-term agreement, patients with Anthem Blue Cross insurance will regain in-network access to their Scripps Health doctors and hospitals until September 30, 2026.

Many patients with an Anthem Blue Cross benefit plan can again access Scripps services without incurring Anthem’s out-of-network fees until September 30, 2026.

This extension allows Anthem patients to regain in-network access to Scripps Health while Scripps and Anthem negotiate the terms of a sustainable, long-term agreement. Our priority remains our patients and their ability to access high quality care without barriers due to problematic policies, while ensuring fair payment to Scripps for its hospital and physician services. Our goal is to reach an agreement before the extension ends, so that patients with Anthem insurance can continue to access Scripps Health. 

In the meantime, we welcome you to schedule appointments and visit any of our locations as you normally would until the extension ends on September 30, 2026.

Scripps is always available to answer questions. You can contact us at 1-800-SCRIPPS Monday through Friday, 7 am - 7 pm PT. We want to ensure you have the information you need to get the care you and your family need.

Call Anthem at the number on the back of your insurance card to learn about benefit and claims questions.

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 reasons (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 pre-authorization, 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.

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

*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.