Dive Brief:
- Mount Sinai and Anthem have failed to reach a new contract, sending thousands of New York residents out of network at the major hospital system.
- The two companies started renegotating their contract last spring, but discussions sputtered close to the end of the year. Despite deadline extensions, Mount Sinai and Anthem failed to come to an agreement by the end of the day on Tuesday.
- Both parties blamed each other for the breakdown, with Anthem saying Mount Sinai is demanding provisions that would drive up unnecessary spending and Mount Sinai saying Anthem is offering terms that would undermine patient care.
Dive Insight:
Contract squabbles between payers and providers are nothing new. But disputes are increasingly creeping into the public eye, as insurers try to keep a lid on increasing medical costs and providers seek generous rate updates, citing inflation and higher costs of doing business.
Providers are also upset about contractural provisions like prior authorization requirements that allow payers to delay care, ostensibly to ensure it’s medically necessary.
The disagreement between Anthem, a subsidiary of the insurance giant Elevance, and Mount Sinai appears to centered around such terms, according to statements from both companies.
“Despite our best efforts to keep Mount Sinai doctors and hospitals in our network, Mount Sinai executives have refused our offers to do so,” Anthem said in a statement Wednesday.
The payer said that Mount Sinai had agreed on price increases but wanted Anthem to remove “contractural safeguards” protecting patients and employers from “billing errors and unnecessary costs.”
“These negotiations are about more than rates. They are about Anthem’s chronic denials of medically necessary care, delayed payments, and administrative practices that create barriers for patients and physicians alike,” Mount Sinai said in a statement on its website.
Following the collapse of the contract, New York hospital giant Mount Sinai’s physicians were removed from Anthem’s network on Jan. 1, though state law mandated patients wouldn’t be affected until March 1.
Mount Sinai’s hospitals and facilities were removed on March 4, according to notices from the companies.
About 200,000 Anthem members receive care from a Mount Sinai provider each year and will be affected, an executive from the system told CBS News last month.
Anthem and Mount Sinai are continuing negotiations, and hope to come to new contract terms, both companies said.
In the meantime, Anthem members in an ongoing course of treatment at Mount Sinai — for serious illnesses, pregnancy care or other conditions — will be able to remain with their physicians. But other patients should reschedule their care with a different in-network provider, Anthem recommended, or potentially be saddled with out-of-network bills.
Patients are often caught in the middle during contract squabbles between healthcare giants, forced to choose between their insurer and their providers. Providers especially are increasingly likely to publicize contract spats, hoping that patients worried about losing their doctors will pressure insurers to keep them in-network.
“Call Anthem at the number on the back of your insurance card and demand they come to an agreement that reinstates your access to the Mount Sinai providers and services you know and trust,” Mount Sinai urged on its website.
Elevance is not the only major insurer Mount Sinai is going out of network with for 2026. The nonprofit system also terminated its contracts with certain Molina plans.
