Anthem, Mount Sinai Remain At Negotiating Table As Contract Deadline Looms

OCEANSIDE, NY. — 9,000 Mount Sinai Health System physicians across New York City and Long Island are set to leave Anthem Blue Cross and Blue Shield’s network in the new year, as the healthcare provider and insurance company both said this week that Mount Sinai treatment would begin leaving the insurance network if no deal was reached to keep Mount Sinai in-network by Jan. 1.

The negotiation covers anthem members on both commercial and medicaid plans. Updates from both sides of the negotiating table said that Mount Sinai physicians would leave the network on Jan. 1 if no agreement is reached, while Mount Sinai hospitals, outpatient centers and other facilities would follow at the end of February.

At the center of the negotiation is a proposed rate increase: Anthem said Mount Sinai was seeking a, "50% price increase for patients covered through employer-sponsored health plans over the next 36 months," Friday, while Mount Sinai said rate increases were needed to maintain care standards at its facilities, calling the proposed hikes, "reasonable."

"The quality of our care is second to none in New York, and our costs to provide these vital services are the same as any other local academic health system’s. Yet Anthem currently pays us up to 35 percent less than they pay our peers in New York," Mount Sinai said. "We have proposed reasonable rate adjustments that would only begin to close this gap. Anthem’s claim that our proposal would increase the cost of any specific service is baseless; we have never had a conversation with them about payments for specific services."

There are some exceptions to the split, as Mount Sinai indicated in a Dec. 2 statement that transplant-related care would remain in-network past the expiration date for Anthem-insured patients. In a Wednesday statement, Anthem said patients being treated for cancer, chronic illness and pregnancy would still have the chance to see Mount Sinai doctors for some time after the two separate.

While the contract negotiations remain contentious, representatives from both sides agreed on one point: The best way for patients to figure out if their treatment would be covered by insurance post-separation would be to call the insurance company directly.

“Determinations regarding eligibility and approval for continuity of care are ultimately up
to Anthem," Mount Sinai said in a letter to patients. "Unfortunately, Mount Sinai physician practices do not have access to or influence over these determinations and cannot provide additional information about individual cases."

Anthem representatives confirmed Friday that directly contacting the company would be the best way to clear up questions of coverage.

Twelve days before the new year, however, the two sides have no agreement in place to keep Mount Sinai facilities in-network at Anthem.

"Negotiations continue and Anthem remains committed to reaching an agreement without care disruption for members," Anthem said in a Wednesday statement. "Anthem is equally focused on improving healthcare affordability for patients, families, employers, unions, and municipalities who are already strained by high costs for care."

"While we value our longstanding relationship with Anthem and greatly desire to remain in their network, we also need to come to an agreement that reflects the excellence of the care Mount Sinai provides, reimburses us fairly, and simplifies the administration of our new agreement," Mount Sinai said.