Anthem Blue Cross patients regain access to Scripps Health

Four months after the contract between Scripps Health and Anthem Blue Cross lapsed, forcing an estimated 125,000 San Diego County residents to consider changing their coverage or finding different doctors, the medical provider announced Tuesday afternoon that the previous relationship has been restored.

Scripps notified patients by email that those with Anthem Blue Cross health insurance coverage can immediately resume making appointments with its approximately 3,000 affiliated doctors and using its network of hospitals and medical offices throughout the region.

In the fall of 2024, Scripps notified patients that the contract with Anthem might not be renewed, citing disagreement with the carrier over reimbursement rates and what the provider said were burdensome requirements for prior approval of billable medical procedures.

Richard Neale, a corporate executive vice president and Scripps’ chief growth officer, said Tuesday afternoon that the new agreement with Anthem simply extends the terms of the previous contract through Sept. 30, 2026.

Disagreements over reimbursement and prior medical approval remain unresolved.

“This is an extension, it is not a new agreement,” Neale said. “So, in a long-term sustainable agreement … those two priorities, which are really breaking down the barriers that interfere with the patient’s ability to get the care that their physician is recommending and to ensure that Scripps gets fair payment, those will be the focal points … that we will be focused on negotiating during the extension period.”

Little information was available on just how many of the more than 125,000 local Anthem beneficiaries stayed with the carrier, hoping for a quick resolution and how many decided to choose a different carrier during the annual open enrollment period, which usually occurs in the fall.

Anthem did not provide information on how many changed carriers or how many health management organization beneficiaries it switched to different local medical providers when Scripps went out of network on Jan. 1.

“We are pleased Scripps Health has rejoined our local network of care providers in San Diego and we look forward to continuing our partnership,” said Beth Andersen, president of Anthem Commercial Health Plans in California, in a statement. “Our members and employer customers remained our number one priority as we worked hard and in good faith to find common ground and reach agreement with Scripps.”

The news came as a relief to many patients Tuesday.

Ron Stolberg of Rancho Penasquitos said that he left Scripps for Sharp HealthCare while his wife tried to stay with Scripps as much as was possible, though some tests needed in the past four months went to Sharp.

“I think it’s great news for those of us that value our history with Scripps, but for many of us, we have gone on and made new relationships with health care providers in other systems,” Stolberg said. “If this was going to get worked out, it would have been great to do it before over 100,000 consumers stressed other health care systems.

“It’s hard to know what to do now, be faithful to a new provider who took us in, or the one we know better but dismissed us over a contract dispute.”

While he said he is on the fence, he said his wife plans to return to Scripps as soon as possible.

Why not extend the contract last year rather than waiting for four months? Neale said that an extension was not on the table.

“We had actually recommended or proposed to Anthem at that time to extend the terms of the existing agreement to negotiate that long-term agreement,” Neale said. “At that time, they turned us down.”

It does not appear that Scripps suffered much financially during the short-lived Anthem divorce. Revenue from third-party payors, for the most part commercial health insurance companies, actually increased slightly in the first three months of 2025 compared to the same period in 2024, according to quarterly financial reports filed with the state. Scripps confirmed the trend in an email Tuesday.

Neale said that patients with preferred provider or exclusive provider organization insurance, which allows beneficiaries to self-refer to any doctor in their network, immediately gain access, while those with health management organization coverage must go through Anthem.

“For EPO or PPO members, they can call (Scripps) today to get an appointment,” Neale said. “HMO members, they need to call Anthem to seek reassignment to a Scripps provider.”

The new contract does not include Anthem plans on the Covered California health insurance exchange. Neale declined to elaborate on why these plans will not regain Scripps in their provider networks. The executive did say that there were about 14,000 Scripps patients in Covered California Anthem plans at the end of 2024, though some may have switched health insurance companies during annual open enrollment in the fall and early winter of 2024 to retain access to Scripps.

©2025 The San Diego Union-Tribune. Visit sandiegouniontribune.com. Distributed by Tribune Content Agency, LLC.