Scripps Health now out-of-network for Anthem Blue Cross policyholders

SAN DIEGO (FOX 5/KUSI) — Following months of uncertainty, Scripps Health has officially become out-of-network for the thousands of San Diegans on Anthem Blue Cross insurance policies.

Negotiations to renew a contract between the health care provider and insurance company had been ongoing since early 2024. The two parties had until midnight Jan. 1, 2025 to come to an agreement, but it no deal was reached.

Now, all patients who hold Anthem Blue Cross health insurance policies — whether from an employer or Covered California — will no longer be able to obtain care at Scripps at in-network costs, according to the health care provider.

Some Anthem policyholders may be able to continue their care with their current doctor through the end of February or as part of Continuity of Care exceptions, a spokesperson for the insurance provider said. Any emergency care at Scripps facilities will also still be covered.

Anthem and Scripps have differing accounts of what led to negotiations failing, with both saying the other was the impetus for the health care provider going out-of-network for Anthem policyholders.

In a statement, Scripps said the dropping of Anthem as an acceptable insurance was "not the outcome we wanted," and that removal of some of the insurer's policies they viewed as influential in unnecessary delays and costs for patients was a sticking point in the talks.

"Anthem’s policies forced 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 provider said.

"We did everything we could to avoid this situation while advocating strongly for our Anthem patients’ and the community’s best interests," it continued.

Anthem, in a separate statement, pinned the decision on Scripps to leave the network, arguing that the provider's demands would have raised the cost for patients to receive care by bumping up the prices it charges Anthem for services covered under its plans.

"We firmly believe our care providers should be reimbursed fairly, including Scripps, and that is reflected in our offers during these negotiations," the insurance company said, adding it offered above-inflation payment increases to the health system as part of the discussions that were consistent with other health systems and the state of California's new spending targets.

"We want Scripps doctors and facilities to return to our network and remain in discussions to reach an agreement that offers affordable prices for the employers and consumers we serve—but we cannot agree to the extreme price increases Scripps seeks to charge patients covered by Anthem," the insurance company's statement read.

With the termination of the contract, most PPO and HMO Anthem patients looking to continue care at Scripps hospitals and with Scripps doctors will need to pay entirely out of pocket for non-emergency services, including covering a portion of estimated charges at the time of care.

Those who received prescription medication from a Scripps physician will need to check with their provider to determine if a refill can be granted. All refill orders that have already been filled will not be impacted. Patients who use Scripps pharmacies will also still be able to obtain their prescriptions through their preferred location, the provider said.

Patients could continue accessing Scripps services at in-network prices by switching to a different insurance plan — like one under Blue Shield, United Healthcare or Health Net — or by moving to a new health care provider that contracts with Anthem — such as UC San Diego Health or Sharp.

Scripps encourages those who need assistance on maintaining health care access with this change to call their customer service line, 1-800-SCRIPPS. The line is open Monday through Friday from 7 a.m. to 7 p.m.