Mount Sinai Contractual Negotiations: Important Update
Active negotiations continue with the goal of keeping Mount Sinai physicians and facilities in the Anthem network. In the meantime, Mount Sinai physicians are considered non-network and will be covered under the Health Plan’s non-network benefits. To find out if your physician remains in the Anthem network or is considered a non-network physician, go to https://www.anthem.com/ca/find-care. Mount Sinai facilities/hospitals will remain covered until March 1, 2026 while negotiations continue.
Key coverage information to be aware of while negotiations continue:
- Facilities/Hospitals: Network cost sharing will be applied to covered services provided and billed by Mount Sinai facilities (e.g., X-rays, labs tests, etc.) until March 1, 2026 in accordance with New York state law, which requires hospitals to remain network for 60 days after a contract ends.
- Physicians: Except for qualifying participants receiving ongoing treatment for a serious medical condition (see bullet #3 below for details), effective January 1, 2026, services provided and billed by Mount Sinai doctors (e.g., routine office visits) are subject to non-network cost sharing (deductibles, co-pays and co-insurance) under the Health Plan.
- Continuity of Care: Anthem’s Continuity of Care guidelines are in place to ensure that participants currently in the middle of treatment are allowed to continue to receive that treatment without being impacted. If you are currently in an ongoing course of treatment at Mount Sinai and the DGA Producer Health Plan is your primary coverage (or your primary coverage does not cover the treatment you are currently undergoing), Anthem will continue to provide in-network coverage under the Continuity of Care guidelines. Under certain conditions, you may qualify for continued care with a Mount Sinai physician and network cost-sharing provisions. Examples of qualifying conditions include:
- Cancer
- Pregnancy
- Serious and complex conditions, including mental health and substance use disorders
- Urgent surgeries that are already scheduled
- Hospitalization
- Treatment for terminal illness
Additionally, those who have already scheduled procedures or surgeries within 180 days of the contract’s termination date (December 31, 2025), those who are hospitalized, or those who are receiving treatment for terminal illness may also qualify.
For more information on Continuity of Care guidelines, visit here. If you think you may qualify for Continuity of Care coverage, please call the Health Plan’s Participant Services Department at 323-866-2200, Ext. 401.
If you are not qualified for Continuity of Care as of December 31, 2025, claims billed by Mount Sinai physicians will be treated as non-network care. This means non-network co-insurance, out-of-pocket limits, etc. will apply to covered services.
NOTE: Contract negotiations do not impact medically necessary emergency services.
Alternative New York Health Systems in Anthem’s Network
The following New York health systems continue to offer network care throughout the contract negotiations:
For more information on the negotiations, visit Anthem’s website.
