As of January 1, 2026, Mount Sinai physicians are currently out of Anthem’s network as contract discussions continue. We remain actively engaged with Mount Sinai and focused on reaching an agreement that keeps providers in-network while protecting affordability for employers and members.
At this time, Mount Sinai is seeking rate increases and contractual provisions that would increase costs for employers and employees by approximately 50% over the next three years. As stewards of our clients’ healthcare dollars, Anthem cannot agree to terms that would significantly raise costs without commensurate value.
Our position
Anthem’s goal remains unchanged: to keep Mount Sinai in-network under a reasonable and fiscally responsible agreement. We have proposed rate increases that exceed CPI and are consistent with—or more competitive than—agreements reached with other New York health systems.
We have also proposed quality-based performance incentives, allowing Mount Sinai to earn higher reimbursement tied to measurable outcomes.
Facility status
Under New York’s required “cooling off period,” Mount Sinai hospitals and facilities are scheduled to exit Anthem’s network on March 1, 2026, unless an agreement is reached prior to that date. Discussions remain ongoing.
Why this matters for your clients
Mount Sinai’s proposals represent the highest rate increase requests Anthem has seen from any New York health system. With approximately 90% of clients self-funded, these increases would directly and immediately impact employer costs and member out-of-pocket expenses.
In addition, Mount Sinai is seeking contract terms that are not standard in New York, including:
- The ability to refuse service to employees of certain employers.
- Exemption from standard audit and review protections.
- New and unprecedented hospital medication fees.
- Shifting unpaid patient cost-sharing responsibility to self-funded employers.
Our commitment
Anthem recognizes Mount Sinai’s role in the community and remains committed to continued discussions. We are actively pursuing an agreement that balances access, affordability, and accountability.
We’re supporting members with continuity-of-care options, transition support, and access to alternative in-network providers where needed.
We appreciate your partnership and will continue to keep you informed as discussions continue. For more information, please contact your Anthem representative.