Anthem, Mount Sinai reach deal to restore health insurance for more than 20,000 Long Islanders

A three-year deal reached late Monday between Anthem Blue Cross Blue Shield and the Mount Sinai Health System will restore health insurance access to more than 20,000 Long Island patients and 90,000 New Yorkers, Anthem announced Tuesday.

The insurance carrier dispute had disrupted in-network health care for Mount Sinai patients since Jan. 1 and ended inpatient hospital coverage on March 1.

The deal will restore coverage for patients seeing their Mount Sinai doctors at 17 Mount Sinai offices on Long Island and access to Mount Sinai hospitals, including in Oceanside and Manhattan. Mount Sinai officials said it would restore access immediately.

The agreement also includes access to Medicaid, Child Health Plus and Essential Plan coverage.

"We recognize this has been a challenging period for patients and providers and are pleased that Anthem beneficiaries will again have access to Mount Sinai’s world-class medical care," Dr. Brendan G. Carr, chief executive officer of the Mount Sinai Health System, said in a statement.

The original contract expired Jan. 1, limiting in-network access to more than 9,000 Mount Sinai doctors under the insurance plan. A 90-day continuity of care clause that allowed some patients, including cancer patients, access to their doctors expired March 31, requiring patients to find inpatient doctors.

The coverage lapse left some patients and families scrambling to find new doctors and treatment.

Tonicha Andrade, of Port Jefferson Station, said she had been with Mount Sinai since 2015 to treat her now-17-year-old daughter Jizelle, who received a rare intestinal transplant that developed into post-transplant lymphoma and a brain tumor.

She has relied heavily on her transplant team of Mount Sinai doctors, but had to seek a second opinion during the insurance dispute. After learning Tuesday's agreement, Andrade said her daughter could resume care with her doctors and cover multiple prescriptions.

"Obviously we prefer to keep all the doctors together. She's not a typical case. Everything that happens to her is rare and Mount Sinai had the doctors that saved her life," Andrade said. "It’s bad enough when families or anyone have health problems. The insurance issue just makes everything so much harder when we're already stressing over the health of our child."

Anthem officials had argued Mount Sinai was seeking price increases exceeding the rate of inflation, while Mount Sinai officials said they were seeking a rate comparable or lower to other regional health providers.

Mount Sinai officials said they were also working to resolve old accounts and $450 million in unpaid claims Mount Sinai has said it was owed by Anthem.

In a Tuesday statement, Anthem said the new contract included "responsible price increases that make cost trends more predictable over time."

The agreement also includes "protections that help ensure hospital bills are accurate, care is delivered in the appropriate setting" and aligns health care costs "more closely with inflation and workers’ wages."

By John Asbury

john.asbury@newsday.comJohnAsbury

John Asbury is a breaking news and general assignment reporter. He has been with Newsday since 2014 and previously worked at The Press-Enterprise in Riverside, California.