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Frequently Asked Questions

What is happening between Mount Sinai and Aetna?

For several months, Mount Sinai Health System has been talking with Aetna about renewing our contract. We are doing everything we can to stay in Aetna’s network and maintain your in-network access to the physicians and services you depend on. In the event our contract expires before an agreement is reached, we may be out of the Aetna network starting on Friday, November 8.

Please note: The following patient groups would not be impacted by the termination:

  • Mount Sinai South Nassau employees insured under Mount Sinai South Nassau’s Aetna employee plan.
  • Icahn School of Medicine at Mount Sinai students enrolled in the Aetna Student Health Plan.

What happens if the contract expires?

In the event our contract expires before an agreement is reached, we may be out of the Aetna network starting on Friday, November 8. This change would apply to both commercial and Medicare Advantage plans.

Please note: The following patient groups would not be impacted by the termination:

  • Mount Sinai South Nassau employees insured under Mount Sinai South Nassau’s Aetna employee plan.
  • Icahn School of Medicine at Mount Sinai students enrolled in the Aetna Student Health Plan.

Why is Mount Sinai in negotiations with Aetna? Why can’t they come to an agreement?

We are in negotiations because our current contract with Aetna expires on Thursday, November 7. To ensure we can continue to provide the high-quality, high-value care our patients depend on, we will need to negotiate a new agreement. Contract negotiations between payers and providers are a routine part of conducting business and lay out the terms for how insurance companies and hospitals and health systems interact. Our goal is always to reach an agreement that allows our patients to maintain their in-network access to the doctors and services they know and trust; while keeping costs low and ensuring we are receiving fair reimbursement that allows us to continue providing care for those who need us.

Which insurance plans would be affected by the contract expiration?

This will affect patients with Aetna plans who obtain their health insurance through their employer, and those insured by Aetna’s Medicare Advantage plans. A network change could cause you to pay more out of pocket in order to continue receiving health care from the Mount Sinai providers you trust.

Does this also apply to Medicare Advantage plans?

Yes. This will affect patients insured by Aetna’s Medicare Advantage plans.

I am a student at Mount Sinai with Aetna insurance. Am I impacted?

No. Please know that in the event our contract expires before an agreement is reached, you will continue to receive care from Mount Sinai physicians and services at an in-network rate.

I am an employee at Mount Sinai South Nassau with Aetna insurance. Am I impacted?

No. Mount Sinai will continue to be in network for Mount Sinai South Nassau employees and their dependents who are enrolled in Mount Sinai South Nassau’s employee health plan with Aetna.

When would Aetna consider Mount Sinai services, physicians and facilities out-of-network?

In the event our contract expires before an agreement is reached, we may be out of the Aetna network starting on Friday, November 8, for patients who obtain their Aetna health insurance through their employer and for patients with Aetna Medicare Advantage plans.

I have an Aetna insurance plan through my employer. Will I still be able to receive care from Mount Sinai if your contract with Aetna isn’t renewed before October 15?

Yes, though Aetna insurance may not cover it. At Mount Sinai, we believe every patient deserves top-quality health care from the doctors, nurses, and teams they trust. Mount Sinai will continue to care for you regardless of insurance status. However, Aetna may require you to pay for a greater portion of your care out of pocket. Contact Aetna at the number on the back of your ID card to verify what your out-of-pocket responsibility would be.

Please know that if you need emergency care, regardless of your insurance status, you should continue to come to our Emergency Departments no matter what. Emergency care is always covered, no matter our contract status with Aetna. Aetna will be required by law to cover the emergency care we provide, and Mount Sinai stands ready to provide that care.

Will emergency care still be covered in network?

Emergency care is always covered, no matter our contract status with Aetna. Aetna will be required by law to cover the emergency care we provide, and Mount Sinai stands ready to provide that care.

Where can I find out more information?

Call Mount Sinai’s dedicated community information line at 833-623-1258.

What can I do to protect my access to care at Mount Sinai?

To protect your right to continue receiving covered care at Mount Sinai:

  • Keep all scheduled appointments and procedures with Mount Sinai, and avoid delaying routine health screenings, procedures, or important tests.
  • If you receive 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.
  • Call Aetna at the number on the back of your insurance card and let them know you want to keep access to the Mount Sinai caregivers and services you know and trust.

Will my out-of-pocket cost increase if Mount Sinai’s contract with Aetna expires?

It will be up to Aetna to determine what portion of your balance they will cover and what portion they will ask you to pay out of pocket. Aetna will likely choose to cover a smaller portion of the balance once they no longer consider Mount Sinai as part of their network.

Review your insurance plan’s out-of-network benefits or contact Aetna to determine your out-of-network expenses if you prefer to continue to receive care from Mount Sinai.

Emergency care is always covered, no matter our contract status with Aetna. Aetna will be required by law to cover the emergency care we provide and Mount Sinai stands ready to provide that care.

Contract Negotiation Glossary

The following are commonly used words in health care and insurance provider contract negotiations:

  • Commercial Insurance: health insurance provided by a private company or entity, such as an employer.
  • Copay: a payment made by an insured patient toward the cost of medical services.
  • Insurance network: the doctors, other health care providers, and hospitals that a health insurance plan contracts with to provide medical care to its members.
  • Insurance plan: financial protection issued by an insurer that pays for or reimburses the cost of receiving care.
  • Network termination: when a health care provider no longer participates in an insurance provider’s insurance network.
  • Out-of-network: when a health care provider does not participate in a health plan’s network of providers.
  • Out-of-pocket: medical care costs that are not reimbursed by insurance.

Have a question that’s not answered here? Contact our dedicated community information line at 833-623-1258.