Protecting Patient Access at Mount Sinai

Our Work With Anthem Blue Cross Blue Shield

Since the spring, Mount Sinai Health System has been working tirelessly to reach a new agreement with Anthem Blue Cross Blue Shield (formerly Empire). Despite these efforts, Anthem has allowed our contract to expire and now considers Mount Sinai out of network.

As of Thursday, January 1, all Mount Sinai physicians are out of network for Anthem plans. This means Anthem may no longer cover physician services at in-network rates, and many patients will pay more out of pocket to continue seeing their Mount Sinai doctors.

Beginning Sunday, March 1, Mount Sinai hospitals and facilities will also be out of network if there is no agreement. At that point, Anthem may stop covering hospital-based care at in-network rates as well, further increasing costs and limiting access for patients who rely on Mount Sinai’s services.

We are disappointed that Anthem did not commit to an agreement before patients experienced disruption to their care. Our priority now is ensuring you understand the options and resources available to you.

What You Can Do Today

  • If you receive your Anthem insurance through your employer, tell your Human Resources or Benefits Department that you want to keep access to Mount Sinai Health System’s high-quality providers and services.
  • Check your out-of-network benefits. Review your insurance plan’s out-of-network benefits or contact Anthem to determine your out-of-network expenses if you prefer to continue to receive care from Mount Sinai.
  • 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.
  • For Medicaid Plans: If you have a new Medicaid plan, you have the option to change your Medicaid plan at any time during your first 90 days with your new plan. You can also change your plan after your first 12 months with your plan.
  • For Essential Plans: Consider changing your Essential Plan to one that Mount Sinai participates with. You have the option to change your plan any time during the year.
  • Anthem may continue to cover your care at in-network rates for a limited period of time through continuity-of-care benefits if you are receiving certain specialty care. Please see below for more information.

To view a list of insurance plans Mount Sinai will participate with in 2026, please click here.

Patient Impact

As a reminder, because our contract has expired:

  • All 9,000 of Mount Sinai physicians are no longer in Anthem’s network as of Thursday, January 1.
  • Mount Sinai’s hospitals and facilities will no longer be in Anthem’s network beginning Sunday, March 1.

View the list below for more information about out-of-network dates for your specific plan. This change impacts all Anthem Blue Cross Blue Shield plans, including out-of-state plans.

When Mount Sinai and Anthem’s contract expires, the date your physician or hospital would become out of network with Anthem may vary depending on your specific health plan. View the list below for more information about out-of-network dates for your specific plan. This change could impact all Blue Cross Blue Shield plans, including out-of-state plans.

Employer-Sponsored Plans

Anthem Plan

Physician Out-of-Network Date

Hospital and Facility Out-of-Network Date

Commercial

1/1/2026

3/1/2026

Con Edison employees

1/1/2026

3/1/2026

Note: Some employer-sponsored plans have special exceptions, which are detailed below

New York State employees

Physicians will remain in network

3/1/2026

Hotel Trades employees

Physicians will remain in network

3/1/2026

32BJ SEIU

3/1/2026

3/1/2026

Milbank

3/1/2026

3/1/2026

Paul, Weiss

3/1/2026

3/1/2026

State and Federal Plans

Anthem Plan

Physician Out-of-Network Date

Hospital and Facility Out-of-Network Date

Child Health Plus

1/1/2026

3/1/2026

Medicaid

1/1/2026

3/1/2026

HARP

1/1/2026

3/1/2026

MLTC/MAP

1/1/2026

3/1/2026

Essential Plan 1-5

1/1/2026

3/1/2026

What You Need to Know

  • Emergency care is always covered, no matter our contract status with Anthem. Your insurance company is required by law to cover emergencies at in-network rates.
  • Out-of-network care often costs more. Without in-network access to Mount Sinai, many patients will pay significantly more out of pocket. We will work with you to help you understand what out-of-pocket expenses you may have if you choose to see us after December 31, and if you do not qualify for continuity of care.
  • Almost all the alternatives are more expensive than Mount Sinai. In many cases, the alternative providers Anthem promotes are more expensive than Mount Sinai without offering similar quality care.

Continuity of Care

If you are currently receiving care from certain Mount Sinai-affiliated specialty providers or using specific specialty services, your health plan may be required to continue covering your care at in-network rates for a limited period of time under continuity-of-care protections.

Mount Sinai has repeatedly attempted to work directly with Anthem to support continuity-of-care requests. While Anthem has approved a limited number of requests, the majority of our patients have not yet received confirmation of continuity-of-care coverage.

Anthem’s approach to continuity of care has created confusion, delays, and additional administrative hurdles for patients seeking to continue their care. In response, Mount Sinai has begun reaching out directly to patients we believe may be eligible for continuity-of-care protections and is doing everything possible to support patients and coordinate their care.

Anthem controls the continuity-of-care review and approval process, but they have declined to work with us to set up a process for easily and efficiently approving patient coverage. Unfortunately, Mount Sinai physician practices do not have access to Anthem’s internal systems or decision-making processes, so we need Anthem’s cooperation to make this process easier for patients.

If you believe you qualify for continuity-of-care coverage and have been unable to get clear information or a response from Anthem, we encourage you to report the issue as follows:

  • If your health coverage is employer-sponsored:
    Call The New York State Department of Financial Services at 1-800-342-3736, or 1-212-480-6400 if you live in New York City. You can also file a complaint through the New York State Department of Financial Services at dfs.ny.gov/complaint.
  • If your coverage is through a government-sponsored plan:
    Call The New York State Department of Health 1-800-206-8125 or email them at managedcarecomplaint@health.ny.gov.
  • If you are employed by Con Edison, please click here.

Mount Sinai’s Position

Mount Sinai has been working in good faith since the spring to reach a fair, responsible agreement before our contracts expired. We remain ready to reach a responsible agreement that protects patients’ access to the physicians and services they know and trust. Although Anthem has reengaged discussions after our contract ended, they offered a proposal that was materially worse than the one they withdrew in November. We cannot move forward toward a resolution if Anthem is moving backward.

Anthem’s public claims that Mount Sinai is demanding “50 percent higher rates” are flatly false. This is a manufactured talking point designed to distract from the real issues in this negotiation. We requested single-digit annual increases over a three-year period.

The facts are straightforward

Anthem pays Mount Sinai up to 35 percent less than other leading New York health systems, even though Mount Sinai is second to none in the quality and complexity of the care we provide. We have asked only for reasonable adjustments that would begin to narrow—not eliminate—this gap. Even with our requested increases, Mount Sinai will still cost less than the other leading systems in Anthem’s network.

Equally concerning is Anthem’s persistent failure to pay what it already owes. Anthem currently owes Mount Sinai more than $450 million for care that has already been provided to its members. That is not a billing dispute—it is care delivered, claims submitted, and payments outstanding. Anthem is effectively using Mount Sinai as an interest-free bank while reporting record profits.

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. Anthem’s business model may be profitable for shareholders, but it undermines access to timely, high-quality care for New Yorkers.

Elevance Health, Anthem’s parent company, is the second largest for-profit insurer in the country with more than $175 billion in revenue and more than $6 billion in profit in 2024. These profits are fed by Anthem’s repeatedly raising premiums for employers and members while underpaying providers who deliver care on the front lines.

Mount Sinai is a not-for-profit health system. Every dollar we receive is reinvested into patient care, medical education, research, and caring for all who need us, regardless of their ability to pay. We cannot—and will not—subsidize a for-profit insurer’s margins at the expense of patient access and financial sustainability.

For any other questions, call one of Mount Sinai’s dedicated community information lines: