Employer and Broker FAQs & Information

Despite our ongoing efforts and advocacy on behalf of your employees — our patients — Anthem is keeping families from the local, high-quality care and doctors they trust at Scripps Health. 

Anthem claims that the company’s unwillingness to reach an agreement stems from their effort to protect affordability. However, public data shows that Scripps Health is below the state benchmark for hospital prices in California. Data also shows that Anthem directly makes healthcare more expensive by raising premiums for customers by nearly 14% from 2024 to 2025 alone. This increase greatly exceeds inflation and certainly exceeds the fair terms Scripps Health is asking for to cover costs. 

Though Scripps has been forced out-of-network as of January 1, 2025, we’re doing everything we can to help Anthem recognize how important it is for our patients to keep the doctors they know and trust in-network, and hope that Anthem will respond with our same sense of urgency for a timely resolution.

We know you take your responsibility to provide your organization’s employees with a benefits plan that meets their needs and preferences seriously. Employees want to be able to see their preferred doctors in convenient locations to keep them and their families healthy. Affordability is important for everyone. But so is access to that affordable care. We’re here to help answer your questions and hear your concerns.

The graphic below from America's Health Insurance Plans shows how $1 of premium is allocated to cover expenses. While less than 60 cents of every dollar is dedicated to care, we don’t control the cost of drugs. Anthem owns a PBM and can certainly have an impact. 

The same as any organization, Scripps Health needs fair payment to keep our doors open and cover the impact of inflation on everything we purchase to deliver patient care – drugs, equipment, supplies, and wages for our staff. Yet our hospital system rates are not what causes an affordability problem. The source of the issue directly traces back to Anthem’s policies and the way it sets pricing for employers and consumers. It’s disappointing that Anthem – the second largest insurance company in the nation – is willing to disrupt its customers’ access to care, refuse requests to address burdensome policies, and prioritize its bottom line over everything else.

This has been demonstrated by Anthem ignoring the assignment of benefits from your employees and clients, and paying Scripps’ reimbursement directly to the employees rather than to Scripps. This forces Scripps to then bill and collect from our patients and not from Anthem. Some states have laws that make this practice illegal, and the No Surprises Act makes this illegal for emergency services provided anywhere in the United States. 

Our only goal in this negotiation is to ensure our patients can continue to access Scripps Health, without unnecessary delays and barriers to the care they need. That is the true issue at the core of the negotiation.