Mount Sinai and Anthem Blue Cross Blue Shield Contract Dispute Impacts Thousands

Contract Dispute and Patient Impact

• 🏥 A contract dispute between Mount Sinai and Anthem Blue Cross Blue Shield threatens to leave thousands of patients without in-network care.
• 🗓️ If an agreement is not reached by March 1st, approximately 9,000 Mount Sinai physicians will be out-of-network for Anthem patients.
• 💸 Patients may be forced to pay hefty prices for out-of-network care or find new doctors.

Callum Davo's Medical Journey

• 💡 Callum Davo, who struggled with severe involuntary tics and breathing issues, was eventually diagnosed with Tourette syndrome at Mount Sinai.
• 🧠 He underwent deep brain stimulation surgery, a life-altering procedure that his family credits with saving his life.
• 👨‍⚕️ Callum and his father, who is also a patient at Mount Sinai for a pituitary gland tumor, together see a total of 10 doctors within the health system.

Negotiation Roadblocks

• 🗣️ Mount Sinai states that negotiations began last spring, but Anthem withdrew all offers and proposals around Thanksgiving, leading to very little contact since.
• 📉 Mount Sinai Health System reports that about 200,000 unique Anthem patients seek care from their providers annually.

Continuity of Care Concerns

• 📢 Anthem stated their priority is ensuring uninterrupted care and understanding patient options, including continuity of care protections for ongoing treatment.
• 🚧 The family argues that the "hoops" required to obtain continuity of care are designed to make it difficult to succeed.
• ❓ The DQo family, covered by Highmark (a separate Blue Cross Blue Shield plan), faced initial confusion but will continue in-network care for now after Anthem connected with Highmark.