At Mount Sinai, we believe every patient deserves to have their insurance cover high-quality health care from the caregivers they know and trust. We work hard to support that coverage through fair agreements with insurance companies. We remain committed to working in good faith to reach a new contract that would preserve access to care for nearly 350,000 patients across New York. However, Anthem has been unwilling to come to a market competitive agreement that prioritizes patient access and alleviates administrative burdens.
Mount Sinai’s Position
Mount Sinai’s Goals:
- Protect patients’ ability to choose and access the high-quality care offered by Mount Sinai caregivers
- Avoid any interruptions in care for patients with Anthem insurance
- Continue our organization’s mission to provide seamlessly coordinated, equitable, and compassionate patient care
Anthem Blue Cross Blue Shield’s Position:
- Unwilling to commit to responsible new agreements that prioritize patient access
- Reimbursing Mount Sinai up to 35 percent less than our peers in New York, according to the Local Law 78 Healthcare Accountability Report
- Refusing to remove administrative hurdles that create barriers to care for patients and result in unnecessary delays in receiving payment for medically necessary services
Based on communications we’ve received from Anthem, it appears that we will not come to terms before our contract expires. As a result, we expect that our 9,000+ physicians will be out of network on Thursday, January 1.
In addition to the unfortunate disruption in care, we believe plan sponsors and patients will incur greater costs as patients may begin to move their care to other providers who are significantly more expensive but not superior to Mount Sinai in quality.
We strongly desire to continue caring for patients with Anthem insurance. We hope that Anthem will commit to new, fair agreements that put patient needs first.
Setting the Record Straight
- Mount Sinai is among the lowest-paid major health systems in New York.
Public data shows that Anthem reimburses Mount Sinai up to 35 percent less than comparable health systems for providing the same or higher-quality care. - Mount Sinai is seeking fair, market-aligned rates that reflect the real cost of delivering care.
Our proposals aim only to begin closing a longstanding payment gap, not to exceed what similar systems receive. Even with the increases we are requesting, we would remain one of the lowest cost options in New York City. - This is about fair dealing and timely payment, not just rates.
A sustainable agreement must ensure that claims are paid accurately, timely, and in an administratively efficient manner, reflecting the full scope of a modern payer-provider relationship. As an example, Anthem has yet to pay Mount Sinai up to $130 million for services rendered prior to April 1, 2024, which is essentially a large interest-free loan. Mount Sinai should not be expected to lend any money to a for-profit organization, let alone a sum this large. - Hospital operating costs have risen much faster than general inflation.
Mount Sinai’s costs are driven by wage growth, workforce shortages, technology and safety investments, and rising supply chain pressures, all of which impact hospitals more than standard consumer inflation. - Mount Sinai did not propose dramatic increases to specific service prices.
We have never discussed changes to reimbursement for individual procedures in this negotiation. Any specific price examples circulating publicly are not based on actual negotiations.
Anthem’s Impact on Patient Care
Anthem creates unnecessary hurdles, which don’t just affect Mount Sinai—they affect patient care. Anthem’s practices make it harder for us to focus on what matters most: our patients and their health.
Extra Red Tape Slows Down Care
Anthem often requires prior authorization before we can provide treatment—even for care your doctor knows you need. This means our team spends hours filling out forms and waiting for approvals instead of caring for patients. These delays can keep you from getting timely treatment.
Denied Claims Disrupt Treatment
Anthem denies nearly 23 percent of claims, even when care is medically necessary. Every denial means more back-and-forth paperwork, which can delay procedures, follow-up visits, and prescriptions. For patients, this can lead to stress, uncertainty, and postponed care.
Late Payments Strain Resources
Even when Anthem approves claims, they often take months to pay. As of December 2025, Anthem owes Mount Sinai millions in overdue payments. These delays make it harder for us to invest in staff, technology, and programs that benefit patients.
Anthem is owned by Elevance Health, a publicly traded for-profit company. Elevance is one of the country’s largest for-profit insurance corporations, and insures more than 350,000 patients across the New York metro area.
In their fiscal year 2025, Elevance enjoyed over $5.5 billion in profits, and approximately $29.5 billion since 2020.
Anthem has consistently raised premiums for patients year over year and has not invested in patient care at the same rate. Unlike other insurance providers, Anthem has refused to consider appropriate rate adjustments to cover expenses.
Anthem has created hardships for patients in recent years by denying staggering numbers of patient claims. A recent analysis showed that Anthem denies about 23 percent of claims for patient care nationwide.
Nationwide, 62 percent of patients have had treatment delayed by their insurer, causing many to become sicker. Anthem is among the insurers cited for these practices.
Mount Sinai is a non-profit mission-driven health care system.
We’re unstoppable in advancing the health of our neighbors, our communities, and the world—pursuing new scientific breakthroughs, educating the next generation of medical leaders and innovators, and delivering the best, most advanced care with compassion, dignity, and respect.
Our mission is to provide safe, equitable, compassionate, and exceptional care with seamless coordination. Our patients are—and always will be—our top focus. By refusing to adequately pay for our services, Anthem is putting at risk our ability to provide the essential care patients need and deserve.
Health care value is a priority for Mount Sinai. Our agreements with insurance companies, including Anthem, prioritize quality over quantity. We prioritize our patients’ well-being and help reduce overall health care costs by focusing on prevention and keeping patients healthy—so they avoid unnecessary hospital visits. Our doctors are rewarded for delivering better, more efficient care and improving patient satisfaction. We are also committed to ensuring that people get the right care at the right time and in the right setting.
Mount Sinai plays a vital role in the community, providing high-quality care to more than 1.3 million unique patients each year. Many of our essential services, especially those for the elderly or those in need, are provided at a loss and account for a significant portion of our budget. Each year, we provide more than $900 million in uncompensated care, ensuring everyone in our community can access the care they need.
