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Anthem and Mount Sinai Split, Leaving Thousands of New Yorkers in Network Limbo
Over 9,000 Mount Sinai physicians are now out-of-network for Anthem members after the two organizations failed to reach a new contract agreement.
Key Points
- Over 9,000 Mount Sinai physicians are now out-of-network for Anthem members after the two organizations failed to reach a new contract agreement.
- The dispute centers on reimbursement rates, with Anthem claiming Mount Sinai demanded a 50% price hike while the health system says it sought single-digit increases.
- Mount Sinai alleges Anthem is withholding over $450 million for previously delivered care, escalating the financial conflict between the two entities.
- The standoff leaves thousands of patients on commercial, state, and federal plans facing higher out-of-pocket costs or the disruption of finding new in-network providers.
Thousands of New Yorkers are scrambling for care after Anthem Blue Cross Blue Shield and Mount Sinai Health System failed to agree on a new contract, pushing more than 9,000 physicians out-of-network as of January 1. The dispute leaves patients caught in the middle of a high-stakes battle over healthcare costs and reimbursement rates.
A fifty-percent feud: The breakup centers on money. Anthem claims the health system demanded a 50% price hike over three years, stating it could not agree to such increases. Mount Sinai fired back, calling Anthem's position a "manufactured talking point" and contending it only requested "single-digit annual increases" to close a gap where it is paid up to 35% less than comparable systems.
Caught in the middle: The fallout leaves people on commercial, state, and federal plans facing higher out-of-pocket costs or the hassle of finding new doctors. While both sides acknowledge that "continuity of care" provisions exist for patients with serious conditions, Mount Sinai insists the process is plagued by confusion and delays, leaving patients with little clarity.
Playing hardball: The dispute goes beyond rates, with Mount Sinai alleging Anthem is withholding more than $450 million for care already delivered, while Anthem's parent company posted over $6 billion in profit in 2024. Anthem countered that Mount Sinai made unprecedented demands, including an exemption from standard claims reviews and the right to refuse treatment for members from specific employers.
The standoff highlights a systemic tension in U.S. healthcare, where patient access becomes a bargaining chip in financial disputes between massive for-profit insurers and non-profit hospital systems. This contract fight comes as major health systems navigate tight financial situations, with a recent report detailing how Mount Sinai is operating on thin margins while implementing a large-scale fiscal improvement plan.
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