Look no further than the Anthem-Mr.Sinai situation in New York. This year, 9,000 Mount Sinai physicians exited Anthem’s network, affecting nearly 200,000 patients in active treatment.
The truth is way more complex than most think.
Fact: Mount Sinai has the lowest reimbursement rate of any central NYC hospital system, based on a recent 2025 Milliman report
Here’s what Anthem actually pays each system, expressed as a percentage of Medicare rates for NYC employee benefits,- which is a good surrogate for commercial rates:
Northwell Health: 316%
NewYork-Presbyterian: 313%
Memorial Sloan Kettering: 277%
NYU Langone Health: 268%
Mount Sinai Health System: 184%
Source: Milliman Report, “Analysis of Facility and Professional Reimbursement for City of New York Comprehensive Benefit Program,” September 2025. Data reflects FY2024 allowed amounts as a percentage of Medicare.”
Read that again. Mount Sinai gets paid 42% less than Northwell for the same services.
So, Why Is Anthem hardlining Mount Sinai?
Because they can.
The fact is, the systems with regional monopolies get paid the most.
Northwell controls Long Island. If you’re an Anthem member in Nassau County who needs cancer surgery, you’re going to Northwell. Anthem knows this. Northwell knows this. So Northwell gets 316% of Medicare.
Mount Sinai is concentrated in Manhattan, where they compete head-to-head with NYU, Presbyterian, and Northwell’s Lenox Hill. Anthem can walk away from Mount Sinai without creating coverage gaps.
So they do.
Correlation isn’t causation. But when the hospital ranked #1 in New York State by Newsweek, and the one with the lowest rates is also the one getting squeezed, and the hospitals with regional monopolies get premium pricing… you tell me what’s happening here?
The Ten Ten Ten Take
Here’s another way we at Ten Ten Ten diverge from everyone else.
Should Mount Sinai be paid more?
No. We believe 180% Medicare should be more than enough for a hospital system to provide excellent care. Mt.Sinai itself is a great example.
We believe the other hospital systems should be paid less. The point of pricing transparency is to drive prices down through competition, not for one hospital system to try to drive prices up. What Anthem should be doing is driving patients to Mt.Sinai, not away from it.
Mount Sinai demonstrates that world-class care can be delivered at 184% of the Medicare rate. So why are we paying 316% elsewhere?
The Anthem-Mount Sinai fight reveals that price in American healthcare has nothing to do with costs, quality, or patient outcomes.
It’s about who has power.
Follow for more analysis that cuts through the noise.
#healthcare #healthcarepricing #transparency #tententenhealth
Originally published by Bhargav Raman, MD
Cofounder, Clinical Strategy and Analytics
https://www.linkedin.com/posts/universalistmd_healthcare-healthcarepricing-transparency-activity-7416849056272064512-Q79T/
