Thousands of Long Island residents insured by Anthem Blue Cross Blue Shield enter the new year facing uncertainty over their medical care after contract negotiations between the insurance plan provider the Mount Sinai Health System broke down, leaving physicians out of the Anthem network as of Jan. 1 and hospitals potentially following in March.
The lapse affects roughly 9,000 Mount Sinai physicians, who are no longer considered in-network providers for Anthem members. If no agreement is reached, all Mount Sinai hospitals and facilities — including Mount Sinai South Nassau, in Oceanside — are scheduled to leave the network on March 1.
Patients now find themselves caught in the middle of a dispute they had no role in creating.
Amy Potter, of Long Beach, whose husband, Van, recently survived a massive cardiac arrest, said the timing of the dispute has left her family shaken. Van was admitted to Mount Sinai South Nassau’s intensive care unit on Dec. 22 and discharged on Dec. 31 — one day before the Mount Sinai-Anthem contract expired.
“When my husband was in critical condition in the ICU, the last thing I was thinking about was whether our insurance would cover the cost of the critical care he was receiving,” Potter said. “I can’t even imagine what our family would be facing in the months ahead if the timing had been different.”
Both Amy and her husband received letters this week notifying them of the changes. With months of follow-up recovery and rehabilitation ahead, the uncertainty, she said, is overwhelming.
“We don’t know at this point if he can continue his care with his Mount Sinai doctors or if we’ll need to find in-network doctors elsewhere,” Potter said, describing his care at MSSN as “exceptional and lifesaving.”
“It’s also scary to consider that our local hospital is no longer the one that we would go to in an emergency because it no longer accepts our insurance,” she added.
Under state and federal law, emergency care must still be covered at in-network rates regardless of contract status. However, non-emergency care provided out of network can result in significantly higher out-of-pocket expenses, including increased deductibles and coinsurance.
Mount Sinai officials warned that many patients might pay more to continue seeing their doctors, especially those who do not qualify for continuity-of-care protections. The health system also disputes Anthem’s claims that alternative in-network providers offer comparable quality at lower cost.
“Almost all the alternatives Anthem promotes are more expensive than Mount Sinai without offering similar quality care,” Mount Sinai officials said in a statement.
Anthem disputes that assertion, saying that “every other major health system in New York remains in our network, including NYU Langone Health, New York-Presbyterian, Northwell Health and Montefiore Health System.”
At the center of the dispute are sharply conflicting claims about costs. Mount Sinai says it sought single-digit annual rate increases over a three-year period, and argues that Anthem currently pays it as much as 35 percent less than other major New York health systems. Mount Sinai also claims that Anthem owes more than $450 million for care already delivered, accusing the insurer of delayed payments and administrative denials that burden patients and providers.
“These negotiations are about more than rates,” Mount Sinai said in its statement. “They are about access to timely, high-quality care.”
Anthem, whose parent company, Elevance Health, reported more than $6 billion in profit in 2024, rejects those claims. The insurer says that Mount Sinai is demanding a 50 percent increase over three years, which would add more than $1 billion to regional health care costs.
Anthem provided examples of what it claimed the increases could mean for patients, including $10,500 more for childbirth, $52,000 more for open-heart surgery and $8,500 more for knee replacements. Mount Sinai disputes those figures.
“Your definite out-of-pocket cost is going to be greater,” James Donnelly, of the nonprofit Pulse Center for Patient Safety, said. “Continuity of care can help, but those protections are limited.”
Continuity-of-care provisions can allow patients undergoing treatment for serious conditions — such as cancer, pregnancy, terminal illness or scheduled surgeries — to temporarily continue seeing their Mount Sinai doctors at in-network rates. Those protections typically last about 90 days.
Mount Sinai says it has attempted to coordinate continuity-of-care approvals, but claims Anthem controls the process, and has not provided clear guidance. Anthem says it is contacting eligible members directly and helping them through the transition.
Under New York law, hospitals must remain in-network for 60 days after a contract expires, offering short-term protection for patients. However, that clock is already running.
Medicaid and Essential Plan members may have more options. Medicaid enrollees can change plans within the first 90 days, while Essential Plan members can switch insurers at any time during the year to maintain access to Mount Sinai providers.
Mount Sinai is urging employer-sponsored plan members to contact their human resources departments and Anthem directly to advocate for a resolution. Anthem encourages members to review their benefits and use its online tools to locate in-network providers.
Despite months of negotiations, there is no immediate sign of a deal.
“We are committed to reaching an agreement,” Anthem said in a statement, adding that it cannot agree to “extreme price increases” that would raise premiums and out-of-pocket costs.
Mount Sinai, a nonprofit system, said it reinvests revenue into patient care, education and research and “cannot subsidize a for-profit insurer’s margins at the expense of patient access.”
As the March 1 deadline approaches, thousands of Long Islanders are left waiting, hoping negotiations resume before their options narrow even further.
