Improving Healthcare Affordability in New York

Here's What's Happening

Anthem’s contract with Mount Sinai ends on December 31, 2025. This agreement sets the rates Mount Sinai currently charges Anthem members.  If we don’t reach a new agreement, Mount Sinai will become out of network on these dates:

• January 1, 2026 — Mount Sinai physicians
• March 1, 2026 — Mount Sinai hospitals, outpatient centers, and all other facilities

New York law requires hospitals to remain in-network for 60 days after a contract ends. Mount Sinai's refused our requests to align all exit dates to March 1 to reduce confusion and allow more time for negotiation.

Unfortunately, Mount Sinai’s administration has a recent history of putting patients in the middle of health plan negotiations. In recent talks with other health plans, they have also used care disruption and patient fear as leverage to charge higher prices. Despite this, we remain committed to working collaboratively with Mount Sinai to keep your healthcare accessible and affordable.

We are asking Mount Sinai to align their price increases with other New York hospitals and with benchmarks such as general inflation and wage growth for New York workers.

We’re also concerned that Mount Sinai administrators have demanded terms that are not in place with any other hospital. Here are two examples:

• Exemption from standard claims review: These reviews protect our members from potential overbilling. Exempting Mount Sinai could lead to potential incorrect or inflated bills and add an estimated 10% to overall patient and employer costs.
• The ability to refuse treatment for certain employers’ members: Even though all of these members are covered by Anthem, Mount Sinai is asking for the right to refuse treatment for people insured through some employers of their choosing. This would lead to confusion, network disruption, and some patients being turned away even though they have coverage. This is an unprecedented demand from a health system founded on the principles of serving all New Yorkers.

Our Members are Our First Priority – How We’ll Help

If Mount Sinai leaves our network, we’ll help minimize care disruption. Whether it’s a serious medical condition, an elective procedure, or finding a new primary care physician, Anthem’s member service team is prepared to help.

• If you’re currently in treatment at Mount Sinai for a serious or complex health condition like cancer, pregnancy, or certain other conditions, you may continue to see your doctor or going to your hospital. Your care will continue throughout your treatment. There is nothing you need to do.

• If you’re not currently in treatment for a serious condition, we recommend scheduling or rescheduling elective care at one of our many high-quality in-network health systems. Every other hospital system in the Tri-State area participates in our network. For help, log in to Anthem.com or the Sydney Health® app or call our member service center.

Our goal is to avoid any care disruption, but we’re preparing support options to minimize care disruption. We are working with other network partners—especially primary care providers—to ensure access to appointments. 

If Mount Sinai leaves our network, our members will still have broad access to high quality care from every other major health system in New York, including:

• NYU Langone Health
• New York-Presbyterian
• Northwell Health
• Montefiore Health System

Provider networks vary by plan. We always recommend you log in to Anthem.com or the Sydney Health® app to find in-network care providers near you. You may also contact our Member Service Center at the number on your Anthem ID card for assistance.

Why We’re Fighting for Your Healthcare Affordability

Healthcare costs are already an enormous strain on putting immense pressure on New York families and employers.

• About half of U.S. adults say it’s difficult to afford healthcare costs and, alarmingly, one in four adults delayed needed care because of high costs (KFF). When hospitals raise prices, patients pay more—through higher copayments, deductibles, and insurance premiums.
• Employers face the same challenge. About 90% of New York employers pay healthcare claims directly—so a sudden jump in hospital costs would drastically increase their expenses. For others, higher hospital prices mean higher insurance premiums, which can limit wage growth, hiring, and investment.
  

That’s why we negotiate on behalf of our members as well as New York unions, employers, and taxpayers to secure affordable care with our care provider partners.