Anthem asks regulators to probe Sentara after contract scuffle

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Anthem is asking Virginia state regulators to investigate alleged anticompetitive behavior from Norfolk, Va.-based Sentara Healthcare after the provider threatened to end its contract with Anthem's Medicare and Medicaid lines of business. 

In a letter obtained via a Freedom of Information Act request by the Virginia Mercury, Anthem asks Mark Herring, Virginia attorney general, to investigate concerns of Sentara's "anticompetitive harm" after it threatened to terminate Anthem's Medicare and Medicaid members' in-network access to Sentara facilities and physicians in April. The termination never happened, as Sentara rescinded its termination notice Aug. 16, the Mercury reported.

Anthem claims that Sentara's market share in the state put the insurer's Medicaid and Medicare members at a disadvantage, potentially "forcing them to travel unnecessarily long distances to seek in-network care from other providers," the letter said. Sentara's April contract pushback could have affected 525,000 Medicaid patients, according to the Mercury

The insurer implored the state to issue regulations that prevent retaliatory termination notices, especially for hospitals that also own managed care organizations. Anthem claims in the letter that Sentara's termination notice was in retaliation to the insurer's commercial Specialty Rx Program and Medicaid outpatient site-of-service initiative. 

A Sentara spokesperson told Becker's that the conflict with Anthem revolved around the insurer's unilateral policies that Sentara and national advocacy organizations believe sacrifice patient well-being. 

While Sentara said it does not comment on the details of its contractual relationships, the spokesperson told Becker's that the provider's integrated delivery system helps keep costs low for all patients — including Anthem members. 

They also noted that while Sentara commands 32 percent of the government program market share over Anthem's 25 percent, Anthem maintains 40 percent of the commercial insurance market in Virginia. That figure is greater than the next four insurers combined, according to the spokesperson. 

This story will be updated as new information becomes available.

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