Important Insurance Update for Anthem Patients Planning Surgery

We understand that changes involving health insurance can be confusing and may raise questions about your care. Tidewater Orthopaedics is committed to helping our patients understand what is changing and what steps they may need to take.

What is happening with Anthem and Sentara?

Beginning in 2027, certain Anthem health plans will consider Sentara facilities to be out of network.

Anthem Medicare Advantage and ACA Exchange plans are expected to become out of network with Sentara beginning January 1, 2027. Anthem Medicaid plans are expected to become out of network beginning January 28, 2027. Commercial or employer-sponsored Anthem plans are expected to become out of network beginning January 1, 2027, although negotiations are ongoing. 

Because coverage varies by plan, Anthem members should contact Anthem using the Member Services number on the back of their insurance card to confirm whether this change applies to them.

What does this mean if I am a Tidewater Orthopaedics patient?

This change does not affect appointments or care provided at Tidewater Orthopaedics’ clinic locations.

Tidewater Orthopaedics will continue to see Anthem patients at our clinics according to each patient’s individual insurance plan, benefits, and coverage.

What does this mean if I am considering surgery with The CarePlex Orthopaedic Ambulatory Surgery Center in 2027?

The CarePlex Orthopaedic Ambulatory Surgery Center is affected by the Anthem and Sentara network change. As a result, some Anthem patients may no longer have in-network coverage for procedures performed at the surgery center beginning in 2027.

What should I do if I am considering surgery?

If you have an Anthem health plan and are considering surgery at the CarePlex Orthopaedic Ambulatory Surgery Center in 2027, our team is here to help you navigate this change. We will work closely with you and your provider to explore opportunities to schedule your surgery before the end of 2026, when medically appropriate and scheduling allows, so you can make the most of your current in-network benefits.

We recognize that insurance network changes can affect your surgical plans and create additional questions. Our team will work with you to identify appropriate next steps based on your care needs, insurance coverage, and available scheduling options.

How can I confirm my insurance coverage?

Because benefits and network participation vary by plan, please call the Member Services number on the back of your Anthem insurance card. Anthem can confirm:

• Whether your specific plan is affected
• Whether the CarePlex Orthopaedic Ambulatory Surgery Center will be in network for your plan in 2027
• Your benefits and estimated financial responsibility
• Whether authorization is required for your procedure

Who should I contact at Tidewater Orthopaedics?

For questions about an upcoming surgery or to discuss scheduling options, please call Tidewater Orthopaedics at (757) 827-2480.

Please note that surgical scheduling is based on medical appropriateness, your provider’s recommendations, insurance authorization, and appointment availability. Insurance coverage and patient financial responsibility are determined by your individual health plan.