Why We're Standing Up for Affordable Healthcare

Unaffordable healthcare is inaccessible healthcare. New Yorkers are already facing a healthcare affordability crisis, and we’re working to protect our members from price increases that would make care harder to afford. For the past 7 months, we have made good faith efforts to reach an agreement with Mount Sinai that keeps care from their doctors and hospitals as affordable as possible.

What Mount Sinai is Demanding—And Why It Matters to You

Unfortunately, Mount Sinai executives are demanding price increases of more than 50% over the next three years – far outpacing inflation and wage growth.

They also want to remove standard provisions that protect patients and employers from being overcharged.

If we accepted these proposals, insurance premiums, out-of-pocket costs, and employer healthcare expenses could rise significantly, further contributing to the healthcare affordability crisis New Yorkers are already facing.

Our goal is simple: to protect your access to high-quality care at prices that are as affordable as possible
 

What Changed in the Network—and When

• Anthem’s contract with Mount Sinai ended on December 31, 2025. Because we couldn’t reach a new agreement:
  Mount Sinai physicians are no longer in-network care providers for all Anthem plans.
• Mount Sinai hospitals and facilities are no longer in-network for Anthem Medicare Advantage plans.
• In-network coverage for care at Mount Sinai hospitals, outpatient centers, and all other facilities continues until March 1, 2026, for Anthem employer-sponsored, individual, and Medicaid plans. New York law requires hospitals to remain in-network for two months after a contract ends.

While we tried to maintain in-network status through March 1 for both doctors and hospitals to allow more time for negotiations, Mount Sinai executives refused, causing unnecessary confusion for our members.

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’ve made multiple fair offers to Mount Sinai that would 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 executives have demanded terms that are not in place with any other hospital that would hurt our members’ access to affordable care. Here are just two examples of many:

• 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. Over the last three years, these reviews caught more than $100 million in incorrect charges to Anthem members.
• Refusing treatment to patients covered by certain employers: Even though all of these members are covered by Anthem, Mount Sinai executives are 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’re Helping

Every other hospital system in the Tri-State area participates in our network, which means our members still have many great options for affordable, in-network care. 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 you.

• If you’re currently in an ongoing course of treatment at Mount Sinai, Anthem will continue to provide in-network coverage under Continuity of Care guidelines. Examples of conditions that qualify for Continuity of Care include cancer, pregnancy, ongoing treatments for serious and complex conditions, including mental health and substance use disorders, urgent surgeries that are already scheduled, hospitalization, or treatment for terminal illness.
  

• 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.

We have worked closely with our other network partners—especially primary care providers—to ensure access to appointments. Our members 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 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.
  

Mount Sinai executives' effort to increase prices more than four times faster than workers’ wages would only magnify these problems. That’s why we negotiate on behalf of our members to secure affordable care with our care provider partners.