Virginia’s largest hospital system says the state’s biggest health insurer has stopped paying its bills on time. Sentara Health told Anthem Blue Cross Blue Shield of Virginia this summer that the insurer owes more than $105 million in claims already 90 days past due, on top of two smaller billing disputes. The fight over that unpaid money, separate from the network exit both companies have publicized, could decide whether nearly 380,000 Anthem members keep in-network access to Sentara doctors and hospitals starting in 2027. Both sides say nothing changes for patients yet, but the money dispute is now playing out in dueling public statements rather than behind closed doors.
Sentara’s $105 Million Claim Against Anthem
On July 31, 2026, Sentara sent Anthem a formal notice of intent to let several commercial, Medicare and Medicaid contracts expire, the standard first step available to either side in a hospital-insurer contract fight, and one Sentara says followed eight months of negotiations. Buried inside that notice was a specific dollar figure: Sentara says Anthem owes it more than $105 million in claims that are already more than 90 days overdue, money for care Sentara says it has already delivered to Anthem members. Sentara also says Anthem has refused to pay $12 million tied to a 2025 billing settlement and has withheld another $4 million by downgrading the severity of emergency-department visits after the fact, which lowers what Anthem pays for the same treatment.
Aubrey L. Layne, Jr., Sentara’s chief administrative officer, framed the unpaid claims as a mission problem for a not-for-profit system: “We cannot accept an arrangement that requires us to absorb significant losses for critical patient care so that a corporation which continues to report billions in annual profit can make even more.” Layne was pointing at Anthem’s parent company, Elevance Health, a company whose numbers the rate fight below puts in context.
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Anthem Says the Money Dispute Is a Separate Matter
Anthem disputes how Sentara has framed the unpaid-claims figures, though it does not deny a dispute exists. On its own negotiations-update page, Anthem states: “Sentara’s public characterization of these longstanding business matters does not accurately reflect the facts,” adding that the billing issues “remain subject to established contractual reconciliation processes and should not be confused with the current negotiations.” Anthem raises a claims-handling complaint of its own, saying Sentara executives “do not want to follow industry standard claim reviews that protect patients and employers from overbilling” and warning that exempting Sentara from those reviews could lead to inflated bills. Neither company has published the underlying claims data that would let an outside party verify the exact dollar balance on either side.
The Rate Fight Behind the Unpaid Claims
The unpaid-claims fight is unfolding alongside a separate argument over what Anthem should pay Sentara going forward. Sentara says it is seeking a 6.2% blended reimbursement increase; Anthem’s FAQ page says Sentara’s employer-sponsored rate requests run “as much as 30% over the next three years,” which Anthem calls roughly three times wage growth. Sentara counters by pointing to the finances of Anthem’s parent company, Elevance Health, which reported $197.6 billion in total operating revenue for 2025 in its year-end SEC filing and returned $1.5 billion to shareholders through stock buybacks in the first quarter of 2026 alone. In that same first quarter of 2026, Elevance still reported $1.8 billion in company-wide net income. Anthem’s response is that more than 70% of Virginia employers pay their own employees’ healthcare claims directly, so a higher hospital rate reaches household budgets and employer costs before it ever touches Elevance’s profit margin.
Contract Deadlines That Could Cut Off Coverage
Nothing changes for patients today; both companies agree Sentara remains fully in-network while talks continue. But the termination notice sets real dates. Anthem’s own member-update page lists commercial, ACA and Medicare Advantage agreements expiring December 31, 2026, and Medicaid agreements expiring January 27, 2027, if no new deal is reached. The same page names eight eastern-Virginia facilities, including Norfolk General, Virginia Beach General and Williamsburg Regional, that would leave Anthem’s commercial network first, on January 1, 2027, with the rest of Sentara’s Virginia hospitals following a year later, on December 31, 2027, if that line of business also fails to reach agreement. Anthem’s FAQ adds that members already receiving treatment for serious or complex conditions could keep seeing their Sentara provider for a limited time under a continuity-of-care option, even if the two sides never reach a final agreement.
Who Loses the Most If Sentara Goes Out-of-Network
Sentara’s notice singles out which patients have the least room to absorb a network split: those “with the least flexibility to absorb that disruption, seniors, people with disabilities, and lower-income families.” That description points directly at the roughly 380,000 people covered by Anthem’s Medicare Advantage and Medicaid plans in the Sentara service area, groups who tend to have fixed incomes, less transportation flexibility and fewer nearby in-network alternatives if a preferred hospital or specialist drops out of network. Anthem, for its part, lists other Tidewater-area systems, including Chesapeake Regional, Riverside Regional and Bon Secours facilities, as fallback options for members who would need to switch providers. Whether that list actually covers a retiree already established with a Sentara cardiologist or oncologist is the question sitting underneath both companies’ public statements as the January 2027 deadlines approach.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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