Uploaded March 2026 | Updated September 2026, 2 weeks ago
In this episode of The Vitals, we sit down with Dr. Alan Adler to unpack one of the most important issues affecting patients and health systems today: negotiations between hospitals and insurance companies.
As discussions continue between Mount Sinai and Anthem, Dr. Adler explains what is at stake in these conversations, how contract negotiations between major health systems and insurers typically work, and why these agreements can have far-reaching implications for patient access, affordability, and continuity of care.
The conversation also explores the broader economics behind hospital-insurer relationships—how reimbursement rates are determined, what drives negotiating leverage on both sides, and how health systems balance financial sustainability with their commitment to patient care.
🎧 Subscribe to The Vitals and explore more podcast programming from Mount Sinai for expert conversations on the biggest issues in medicine, research, and patient care: youtube.com/playlist?list=PLCT7BA-HcHliU8QIXyuk_74L_uH0gyKGt
To learn more about Mount Sinai services or schedule an appointment with a provider, visit Mount Sinai online today: mountsinai.org/?pk_vid=174eeee090819798177342044977c34c
00:00 — Episode introduction and topic: the historical background of the Mount Sinai vs. Anthem contract dispute.
01:12 — Dr. Adler explains attempts to engage Anthem and how negotiations stalled.
03:24 — History of Mount Sinai’s lower contracted rates compared with other NYC systems.
04:12 — Explanation of patient cost-sharing (deductibles, coinsurance) and financial impact.
10:13 — Mount Sinai reached basis of agreement with Anthem, then Anthem backed out within 24 hours.
12:42 — Continuity-of-care rules and problems patients face getting extensions or correct info.
16:07 — Emergency department coverage remains in-network and implications for urgent care.
29:50 — Conclusion: Mount Sinai urges Anthem leadership to negotiate in good faith; advises patients to contact Anthem, HR, or regulators
In this episode of The Vitals, we sit down with Dr. Alan Adler to unpack one of the most important issues affecting patients and health systems today: negotiations between hospitals and insurance companies.
As discussions continue between Mount Sinai and Anthem, Dr. Adler explains what is at stake in these conversations, how contract negotiations between major health systems and insurers typically work, and why these agreements can have far-reaching implications for patient access, affordability, and continuity of care.
The conversation also explores the broader economics behind hospital-insurer relationships—how reimbursement rates are determined, what drives negotiating leverage on both sides, and how health systems balance financial sustainability with their commitment to patient care.
🎧 Subscribe to The Vitals and explore more podcast programming from Mount Sinai for expert conversations on the biggest issues in medicine, research, and patient care: youtube.com/playlist?list=PLCT7BA-HcHliU8QIXyuk_74L_uH0gyKGt
To learn more about Mount Sinai services or schedule an appointment with a provider, visit Mount Sinai online today: mountsinai.org/?pk_vid=174eeee090819798177342044977c34c
00:00 — Episode introduction and topic: the historical background of the Mount Sinai vs. Anthem contract dispute.
01:12 — Dr. Adler explains attempts to engage Anthem and how negotiations stalled.
03:24 — History of Mount Sinai’s lower contracted rates compared with other NYC systems.
04:12 — Explanation of patient cost-sharing (deductibles, coinsurance) and financial impact.
10:13 — Mount Sinai reached basis of agreement with Anthem, then Anthem backed out within 24 hours.
12:42 — Continuity-of-care rules and problems patients face getting extensions or correct info.
16:07 — Emergency department coverage remains in-network and implications for urgent care.
29:50 — Conclusion: Mount Sinai urges Anthem leadership to negotiate in good faith; advises patients to contact Anthem, HR, or regulators
