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Frequently Asked Questions

What is changing about Mount Sinai’s participation with Anthem NYS Individual Marketplace plans?

  • Effective Thursday, January 1, Mount Sinai physicians are no longer in Anthem’s Individual Marketplace network.
  • Effective Sunday, March 1, Mount Sinai hospitals and clinics will no longer be in Anthem’s Individual Marketplace network.

If you are currently receiving care from certain Mount Sinai-affiliated specialty providers or using specific specialty services, your health plan may be required to continue covering your care at in-network rates for a limited period of time under continuity-of-care protections.

Mount Sinai is committed to helping our patients maintain in-network access to medically necessary care and has made repeated efforts to work directly with Anthem to support continuity-of-care requests. To date, we have been unable to confirm that Anthem has approved continuity-of-care coverage for the vast majority of our patients.

Anthem’s approach to continuity of care has created confusion, delays, and additional administrative hurdles for patients seeking to continue their care. In response, Mount Sinai has begun reaching out directly to patients we believe may be eligible for continuity-of-care protections and is doing everything possible to support patients and coordinate their care.

Anthem controls the continuity-of-care review and approval process, but they have declined to work with us to set up a process for easily and efficiently approving patient coverage. Unfortunately, Mount Sinai physician practices do not have access to Anthem’s internal systems or decision-making processes, so we need Anthem’s cooperation to make this process easier for patients.

What is changing about Mount Sinai’s participation with Anthem Medicare Advantage plans?

  • Effective Thursday, January 1, Mount Sinai physicians are no longer in Anthem’s Medicare Advantage network.
  • Effective Sunday, March 1, Mount Sinai hospitals and clinics will no longer be in Anthem’s Medicare Advantage network.

What is changing about Mount Sinai’s participation with Molina Medicaid, Child Health Plus, HARP, and NY Essential plans?

Effective Thursday, January 1, Mount Sinai physicians, hospitals, and clinics are no longer in Molina’s Medicaid, Child Health Plus, HARP, or Essential Plan networks.

What happens if I continue my insurance coverage through Anthem Medicare Advantage, Anthem Individual Marketplace, or Molina?

If you decide to continue your insurance coverage through Anthem Medicare Advantage, Anthem Individual Marketplace, or Molina, the insurer may require you to pay more out of pocket to continue receiving health care from the Mount Sinai providers you trust. It would mean that you may need to use out-of-network benefits (if available through your plan) and/or pay for your care without the aid of insurance.

Will emergency care still be covered in network?

Yes. All insurance companies are required to process emergency claims as if you were in network, so rest assured that you can always receive emergency care in Mount Sinai’s emergency rooms.