A contract dispute between Sentara Health and Anthem Blue Cross Blue Shield has put roughly 380,000 Virginians on notice that their hospitals and doctors could fall out of network as soon as January 1. Sentara has formally told Anthem it will let their agreements expire if the two sides cannot reach new terms, and the affected group is not limited to commercial plans; it includes Medicare Advantage and Medicaid members across Hampton Roads and beyond. The threat is real but not yet final, which makes the coming weeks a window to plan rather than panic.
What the termination notice actually does
Sentara’s move is a formal step in a payment fight, not an immediate shutoff of care. The health system notified Anthem of its intent to allow certain commercial, Medicare, and Medicaid agreements to expire if a new contract is not signed, a maneuver that pressures the insurer while leaving room to settle. Both organizations have stressed that patients see no change to their coverage today and that a notice of this kind routinely precedes a deal rather than a rupture.
The disagreement underneath the notice is about money. Sentara is seeking an average reimbursement increase of roughly 6.2% for 2027, while Anthem has countered with something closer to a 1% reduction. The health system has also accused Anthem of leaving more than $100 million in claims unpaid past 90 days and of downgrading or denying millions in emergency-department charges, a set of grievances that hardens each side’s position at the table.
For patients, the size of the affected population is what raises the stakes. The dispute reaches nearly 380,000 Anthem members in Virginia, spanning employer coverage, Medicare Advantage, and Medicaid. That breadth means a single stalled negotiation could reshuffle where hundreds of thousands of people can receive in-network care.
The financial mechanics of an out-of-network split are what make the dispute more than a corporate spat. When a hospital system leaves an insurer’s network, the plan typically pays a smaller share of the bill, or nothing for routine services, and the patient absorbs the difference through higher coinsurance or full charges. For a Medicare Advantage member, that can turn a familiar, capped set of costs into a far larger and less predictable one, precisely because Advantage plans lean on network contracts to hold spending down.
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The rolling dates that decide when coverage changes
January 1 is the headline date, but it is not a single cliff for everyone. The contracts are set to lapse on a staggered schedule rather than all at once, so the day a given member loses in-network access depends on the specific plan. Commercial and Medicare agreements are slated to run through at least the end of December, with Medicaid coverage extending into late January before it too would expire absent a deal.
Those rolling dates matter for anyone mapping out surgeries, specialist visits, or ongoing treatment. A Medicare Advantage member and a Medicaid member in the same household could face different cutoff dates, and care scheduled after a plan’s expiration would shift to out-of-network rates unless a new contract is in place or an exception applies. Knowing which category a plan falls into is the first step in gauging real exposure.
The staggered timeline also leaves a bargaining runway. Because a termination notice does not bar either side from continuing to negotiate, agreements of this type frequently settle in the final weeks, sometimes retroactively, which can spare patients from ever feeling the change. That possibility is real, but it is not something an individual can count on when arranging care months ahead.
State and federal rules soften the edge for some patients even if a contract does lapse. Continuity-of-care provisions can let someone in active treatment for a serious condition, a pregnancy, a course of chemotherapy, or recovery from a recent surgery, keep seeing the same providers at in-network rates through a transition period. Those protections are not automatic; they generally must be requested, and they buy time rather than permanence, which is why they supplement a coverage decision instead of replacing one.
What Medicare Advantage members can do before year-end
For the Medicare Advantage members caught in the dispute, the fall enrollment season offers a hedge that other affected groups do not have. Medicare’s annual enrollment period lets a member switch to a different plan or return to Original Medicare before January 1, which can matter when a plan’s value hinges on a specific hospital system staying in network. If Sentara is the reason someone chose an Anthem plan, a network split changes the calculation.
Original Medicare offers a structural contrast worth weighing here, because it is accepted by any provider that participates in Medicare regardless of insurer contract fights. A member who prizes uninterrupted access to a particular health system may find that Original Medicare with a supplement sidesteps exactly the kind of network dispute now unfolding, though that route carries its own premium and underwriting tradeoffs.
The standoff also exposes a structural weakness of tying coverage to a single dominant health system. In a market where one system runs many of the hospitals and physician practices, an insurer contract fight can leave members with few genuinely independent alternatives nearby. Weighing how concentrated the local options are, and whether a competing plan even offers a different hospital network, is part of judging how much protection a switch would truly deliver rather than assuming any change restores access.
Until the two sides either sign or walk away, the honest answer for 380,000 Virginians is uncertainty. The prudent response is to confirm which plan category applies, track the specific expiration date attached to it, and treat the fall enrollment window as the moment to act if a resolution has not landed by then.
This article was produced with AI assistance and reviewed against primary sources by The Money Overview editorial team.
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