Thank you to those who were able to join us for last week’s webinar regarding our ongoing negotiations with Mount Sinai. We appreciate your engagement and partnership as we work to improve healthcare affordability across New York.
If you couldn’t make it, we can catch you up.
Our agreement with Mount Sinai expired on December 31, 2025. Physician services moved out of network as of January 1, 2026, and hospital/facility services are scheduled to leave the network on March 1, 2026, following New York’s two-month cooling-off period unless we come to an agreement.
At the center of these negotiations is affordability. Mount Sinai is seeking a commercial price increase of more than 50% over three years — far outpacing wage growth and inflation. They are proposing unprecedented contract changes that would:
- Allow them to opt out of serving specific self-insured employers or unions at any time.
- Shift unpaid member cost-share responsibility to employers.
- Restrict Anthem’s ability to audit claims and perform utilization management — important tools that saved NY employers from more than $100 million in overcharges over the last three years.
- Require a “pay-now, review-later” model for all lines of business.
- Apply prompt-pay penalties to self-insured employers.
- Limit employer choice around carve-out and specialty vendors.
If agreed to, these changes could add approximately $1 billion in healthcare costs for New York employers and members over the next three years, while weakening critical cost-control protections.
During the webinar, we also addressed several misleading public claims made by Mount Sinai. To clarify:
- Mount Sinai has publicly acknowledged seeking the ability to refuse service to certain employers and unions.
- Claims that Anthem underpays compared to other health plans are highly misleading based on independent transparency data.
- Mount Sinai’s “single digit” annual increases could be as high as 9.9% every year. Combined with the proposed contractual changes, these increases would raise prices at rates 5 times higher than inflation and 4 times higher than wage growth.
- Anthem is actively partnering on Continuity of Care and meeting regularly with Mount Sinai clinical leadership to protect patients in active treatment.
Continuity of Care remains firmly in place. Members undergoing treatment for cancer, pregnancy, behavioral health conditions, scheduled surgeries, hospitalizations, or other serious and complex conditions can continue seeing their Mount Sinai providers at in-network rates for approved timeframes. Our teams are working proactively to ensure smooth transitions where needed.
We remain committed to:
- Collaborative, good-faith negotiations.
- Reasonable rate increases at or close to CPI and wage growth trends.
- Value-based care arrangements.
- Transparent communication.
- Representing your clients’ interests and protecting affordability.
How you can help:
- Educate client leadership teams on the long-term cost implications.
- Reinforce that alternative high-quality care options remain available.
- Share affordability concerns directly with Mount Sinai leadership where appropriate.
- Direct clients to anthem.com/mountsinai for updates and resources.
Thank you for your continued partnership. Please reach out to your Anthem representative with any questions.