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Anthem vs Mount Sinai

Network Contract Watch

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.

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. Mount Sinai stated that Anthem refused to commit to contract provisions designed to protect patients from excessive denials, delayed determinations, and prolonged administrative disputes.

Both parties have indicated they are willing to continue negotiations.

Source: CBS News

UnitedHealthcare vs New York-Presbyterian

Network Contract Watch

New York-Presbyterian Hospital exited the UnitedHealthcare network for individual and family plans on January 1, 2026. The network relationship for commercial insurance (including employer-sponsored plans), Medicaid, and Medicare Advantage plans also expired, but UHC and New York-Presbyterian were able to agree on an extension through March 31, 2026.

The extension does not apply to the individual and family plans, including those purchased via the exchange.

This also affects members of Oxford and Sierra Health Plans.

Sources: New York-Presbyterian, UnitedHealthcare

RESOLVED: Capital District Physician Health Plan vs St Peter’s Health Partners

Network Contract Watch

St. Peter’s Health Partners and Capital District Physician Health Plan are both reporting that they have reached a contract, retroactive to January 1, keeping the provider in-network with the payor. CDPHP is reporting that the contract has been signed, and St. Peter’s is reporting that they have reached an agreement in principle.

Both parties are confirming that patients should expect no network disruptions.

Sources: Capital District Physician Health Plan, St. Peter’s Health Partners

Capital District Physician Health Plan vs St Peter’s Health Partners

Network Contract Watch

A contract dispute between two prominent Capital Region health organizations could disrupt care for more than 100,000 patients.

St. Peter’s Health Partners and the Capital District Physician Health Plan have been in negotiations for months and remain deadlocked on a new deal to replace the current one, which expires on December 31.

No immediate changes to health coverage are expected until the end of February, when a 60-day state-mandated “cooling-off period” expires*. The period is intended to allow patients to receive undisrupted care. However, patients should monitor carefully and make contingency plans.

Both CDPHP and SPHP have created microsites for members.

Source: Spotlight News

 

* The New York mandated cooling-off period only applies to hospitals. However, St. Peter’s is announcing that services will be treated as in-network through February 28 without mentioning hospitals only. If you are unclear about your coverage, call ahead before receiving any care on or after January 1.

Anthem vs Mount Sinai

Network Contract Watch

The provider contract between Anthem and Mount Sinai for Medicare Advantage plans is terminating on December 31, 2025. The parties remain in negotiation for all other types of plans offered by Anthem, including employer-sponsored group plans. If no agreement is reached, they will also go out-of-network on December 31, 2025.

Per provisions in New York law, if the contract lapses, then physicians and providers go out of network immediately. However, there is a 60-day “cooling off” period for hospitals, meaning that the hospitals themselves would remain in-network through February 28, 2026.

Both Mount Sinai and Anthem have published informational sites for affected patients.

Sources: Anthem, Mount Sinai