Contract Negotiations Leave Long Islanders Without Mount Sinai Coverage

Beginning Thursday, many Long Islanders insured by Anthem Blue Cross Blue Shield will find their medical visits at Mount Sinai no longer covered.

The contract between Anthem, based in Indianapolis, and Mount Sinai Health System, located in New York City, expired on Wednesday. The main sticking point in the negotiations revolved around the fees Anthem was prepared to pay Mount Sinai.

Starting on January 1, over 9,000 physicians affiliated with Mount Sinai, including those at 14 clinics in Nassau County and three in Suffolk County, will be classified as out-of-network for Anthem policyholders, as outlined on the Mount Sinai website.

Mount Sinai expressed disappointment, stating, “Unfortunately, Anthem has indicated that a resolution will not be reached before the expiration of the commercial and Medicaid contracts.”

However, Anthem noted that its services at Mount Sinai hospitals, including Mount Sinai South Nassau in Oceanside, will remain available for another 60 days, in line with state regulations.

According to Anthem, patients at Mount Sinai will still receive coverage for ongoing treatment related to cancer, pregnancy, and other serious conditions due to continuity of care protections. The insurer explained that no patients currently undergoing treatment will lose access to their physicians.

“Our continuity of care protection guarantees that members receiving ongoing treatment maintain in-network coverage levels,” Anthem stated. This includes support for medical, mental health, and substance use disorders.

Mount Sinai warned that if an agreement is not reached by February 28, starting March 1, all its hospitals, including the South Nassau location, will be removed from Anthem’s network.

Anthem currently insures around 90,000 residents in New York, per a spokesperson. Specifically, as of November 30, there were 13,702 insured individuals from Nassau County and 6,951 from Suffolk County.

The exact number of Long Islanders covered by Anthem’s Medicaid network wasn’t available immediately.

Anthem reiterated its commitment to ensuring access to affordable care. “While we couldn’t finalize an agreement with Mount Sinai by the deadline, we’ll continue to work to keep their physicians and facilities in our network,” the company communicated.

In a letter to patients, Mount Sinai indicated that only Anthem could authorize continuity of care coverage. The letter emphasized the challenges faced in negotiating continuity for patients and recommended those who believe they qualify for ongoing care to reach out to Anthem directly.