Negotiations between Mount Sinai Health System and Anthem Blue Cross Blue Shield failed, resulting in thousands of patients in New York losing in-network care.
The two parties temporarily extended the deadline Monday for a new contract, but failed to come to an agreement Tuesday night.
About 9,000 Mount Sinai physicians became out of network to about 200,000 Anthem patients when they couldn’t reach an agreement on Dec. 31, but state law mandated no change for patients before March 1.
Mount Sinai said they did finalize a direct contract with the union 32BJ, so those union members will still be able to get in-network care.
Mount Sinai wants price hike, Anthem says
Anthem officials said in a statement that the sides reached an agreement and a contract was ready to go. At the last minute, Mount Sinai refused to move forward “unless we agreed to eliminate basic consumer protections that help make sure care is appropriate and patients are not overcharged,” according to the statement.
“We cannot agree to changes that would drastically increase costs for New Yorkers. We remain willing to reach a responsible agreement and will continue to work with Mount Sinai to return them to our network. In the meantime, our network includes every other major health system in New York City, and we are focused on helping our members get the care they need during this transition,” Anthem officials wrote.
They previously claimed Mount Sinai executives were demanding price increases of more than 50% over the next three years.
$450 million owed to Mount Sinai
Mount Sinai staff also released a statement in response to the termination.
“Over the past several months, Mount Sinai engaged in repeated, good-faith efforts to reach a responsible agreement that would restore in-network access to our patients. Over the last month, we made meaningful progress. After narrowing economic differences, Anthem refused to commit to contract provisions designed to protect patients from excessive denials, delayed determinations, and prolonged administrative disputes. Mount Sinai cannot accept terms that undermine patient care or destabilize our system,” officials said.
Executives previously said Anthem owes Mount Sinai more than $450 million for care already provided to its members.
“There have been a number of times during this negotiation that we felt like we had either formal agreement on key issues or agreements in principle, only to have those walked back by executives at Anthem,” said Brent Estes, senior vice president and chief managed care officer with Mount Sinai Health System.
Estes said Anthem’s claims about Mount Sinai wanting to eliminate basic consumer protections are “completely false.”
“What we asked for is, instead of not being paid anything for care that we provided, when they need to review it, that they need to pay at least something as an interim payment while they conduct their reviews,” he said.
Estes said Mount Sinai is willing to return to the table.
“Patients first, not money”
Queens resident Massiel Lugo’s doctors are now out of network. She took to TikTok in February to express her frustrations over losing insurance coverage at Mount Sinai.
“When you have lupus, our number one enemy is stress,” she said.
Lugo said she is a single mom who works three jobs and needs to be healthy for her kids.
“It was very unfortunate because I’m on a medication. I was going from monthly injections to now weekly injections, so I needed to speak to my rheumatologist more often,” she said, “and I was on a wait list to see another rheumatologist. That was a no-go.”
“I feel like health care should be a universal right for everybody, and it shouldn’t be something that’s just constantly a money grab, is what it feels like,” said Upper West Side resident Susan Kim, who is also scrambling for care.
“I just wish they’d put their patients first, and not money,” Lugo said.
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