Thousands of Long Island residents with Anthem Blue Cross Blue Shield coverage will lose in-network access to Mount Sinai medical offices starting New Year’s Day, after the Indianapolis-based insurer and New York City-based Mount Sinai Health System failed to reach a contract agreement. The two organizations cited disagreement over reimbursement rates as the central issue in negotiations.
Scope of the Coverage Gap
Beginning January 1, more than 9,000 Mount Sinai physicians across 14 medical offices in Nassau County and three in Suffolk County will be considered out-of-network for Anthem members. However, Anthem coverage at Mount Sinai hospitals, including Mount Sinai South Nassau in Oceanside, will continue for an additional 60 days in accordance with state law, according to Anthem’s website. If no agreement is reached by February 28, all Mount Sinai hospitals will also transition out-of-network as of March 1.
Continuity of Care Protections
Anthem stated that patients in active treatment for serious and complex conditions—including cancer, pregnancy, mental health disorders, and substance use disorders—may maintain in-network coverage levels through continuity of care protections. “Patients in active treatment will not lose access to their doctors,” Anthem said in a statement. Mount Sinai noted that only Anthem can approve continuity of care coverage and advised patients to contact Anthem directly using the phone number on their insurance cards to determine eligibility. The health system stated it has been “trying to work with Anthem to make the continuity of care process as simple as possible for our patients, but so far, they have not been willing to partner with us on this.”
Insurance Population Affected
Anthem currently insures approximately 90,000 New York residents. As of November 30, 13,702 Nassau County residents and 6,951 Suffolk County residents were insured by Anthem through NY State of Health, the state health care marketplace. The exact number of Long Island Medicaid enrollees with Anthem was not immediately available.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.newsday.com/news/health/anthem-blue-cross-blue-shield-mount-sinai-cwa8ik49