Protecting Patient Access at Mount Sinai

Our Work With Anthem Blue Cross Blue Shield

Update as of February 10: We remain far apart in our negotiations. Mount Sinai has submitted a new proposal, still requesting only single-digit annual increases that would result in rates that remain well below our peers in New York and that we be paid for care we’ve already provided. Since then, Anthem has rejected our proposal outright while demanding that we send another, without offering a counterproposal of their own. Asking us to negotiate against ourselves is neither productive nor acceptable. Mount Sinai remains ready to negotiate in good faith, but Anthem’s actions are keeping us from making meaningful progress towards a solution. If there is no agreement in place by March 1, patients with Anthem or other Blue Cross Blue Shield plans will be left with a much smaller, lower-quality, and more expensive network.

As of Thursday, January 1, Mount Sinai physicians are out of network for Anthem plans. This means Anthem may no longer cover physician services at in-network rates, and some patients may 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

Please see the table below for information on when physicians and facilities may be out of network for you. Depending on your specific plan or condition, you may qualify for coverage that extends beyond these dates. Decisions on coverage are ultimately up to the health plan, so please call the number on the back of your insurance card if you believe you may be eligible for extended access.

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.

Determinations regarding eligibility and approval for continuity of care are ultimately up to your insurer. Unfortunately, Mount Sinai physician practices do not have access to or influence over these determinations and cannot provide additional information about individual cases.

If you believe you may be eligible for continuity of care, please contact your insurer directly at the number on the back of your insurance card.

We encourage patients who believe they qualify for continuity-of-care benefits but have been unable to get clear information or a response from Anthem 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, but Anthem has not been willing to work with us. We remain ready to reach a responsible agreement that protects patients’ access to the physicians and services they know and trust.

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 are still requesting only 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 $197.6 billion in revenue and more than $5.7 billion in profit in 2025. 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: