Cancer Patient Faces Treatment Uncertainty Amid Provider Dispute
Natalie Reichel is scheduled for her next cancer therapy in March, but a contract dispute between Mount Sinai Health System in New York City and Anthem Blue Cross Blue Shield has jeopardized her ability to receive timely care.
Contract Dispute Details
The ongoing negotiation controversy stems from financial disagreements. Mount Sinai claims that Anthem owes over $450 million in unpaid claims, while Anthem argues that the hospital is demanding a 50% rate increase. As a result, Mount Sinai’s physicians have opted out of Anthem’s network for most plans as of January 1. However, Mount Sinai’s hospitals and facilities will remain in-network until March 1.
Implications for Patients
For patients like Reichel, this means needing special approval from their insurance for continuity of care or potentially finding a new team of specialists to stay on schedule with their treatment. Reichel, who has faced challenges securing such exceptions in the past, expressed her concerns about the situation, saying, “I am feeling dubious.”
Long-Term Health Considerations
Diagnosed with breast cancer at the age of 33, Reichel has been in remission for six years but continues to receive hormone-suppressing shots to minimize the risk of recurrence. Her wife, Red Faolan, is particularly anxious about the possibility of a recurrence due to the aggressive nature of her initial diagnosis.
Hospital and Insurer Negotiations
Negotiations between hospitals and insurers typically take place behind closed doors and are resolved before adversely affecting patients. However, recent years have seen an increase in public disputes, as seen in Reichel’s situation. Researcher Jason Buxbaum reports that from 2021 to 2025, around 20% of hospitals had public disagreements with insurers, leading to numerous patients facing treatment delays.
Economic Pressures in Healthcare
Healthcare costs are rising, prompting mounting disputes between the two sectors. The American Hospital Association has noted a 5.1% rise in total hospital expenses in 2024, surpassing the overall inflation rate. “Hospital prices have grown tremendously,” stated Leemore Dafny, a public policy professor. The financial strain is compelling both sides to negotiate aggressively, often resulting in adverse outcomes for patients.
Looking Ahead
As negotiations continue, Reichel’s situation remains precarious. While Mount Sinai’s chief managed care officer, Brent Estes, is open to reaching a new agreement with Anthem, the insurer’s spokesperson has emphasized financial concerns in their negotiations. Meanwhile, Reichel is working to secure approval from her insurer to maintain access to her current healthcare providers. “I’m feeling like I’ll be jumping through a whole bunch of hoops just to have to jump through a bunch of hoops again,” she lamented, reflecting on her experience navigating this complex, stressful system.
