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We believe it is essential for Anthem Blue Cross Blue Shield New York to ensure their plans provide access to Memorial Sloan Kettering Cancer Center’s (MSK) life-saving cancer care. For several months, MSK has been engaged in discussions with Anthem to renew our contract and keep MSK as an in-network provider. Despite our best efforts and commitment to negotiating in good faith, Anthem has refused to enter a reasonable contract that ensures uninterrupted access to MSK.
As a result, Anthem may no longer include MSK as an in-network provider starting January 1, 2025.
While we have worked tirelessly to reach a fair agreement with Anthem, they have refused to agree to reimbursement rates on par with other academic institutions, even with the knowledge that MSK has lower overall costs and produces superior patient outcomes. MSK will continue to negotiate, but we believe it’s important that we give our patients advance notice of this potential change in their coverage so they can explore other options, including during the open enrollment for benefits that many employers offer in the fall.
What Patients Need to Know
- MSK will remain in-network with Anthem through December 31, 2024. Starting January 1, 2025, MSK may no longer be part of Anthem’s network. However, because of New York State’s required 60-day “cooling off” period, the terms of the current contract will be in effect until March 1, 2025.
- To minimize disruption to our patients, any patient with Anthem insurance who receives treatment prior to March 1 can continue to receive treatment as long as necessary under the provisions of the in-network contract. This applies even if treatment extends beyond March 1, 2025.
- MSK has mailed a letter to our patients with Anthem insurance to update them on these potential changes.
- Patients will receive a separate notification from Anthem or their Blue Cross plan detailing when their coverage will change and how to register for continuity of care.
- Patients with out-of-network benefits through Anthem can still access MSK in accordance with the terms of their benefits.
What Can Patients Do To Continue Their Care at MSK in 2025?
- Call the number on the back of your insurance card and tell them you want Anthem to keep MSK as an in-network provider.
- If your insurance is provided through your employer, talk with your human resources (HR) or benefits department and ask them to support keeping MSK in-network with Anthem.
- If you’re able to choose a new insurance provider, MSK has relationships with many insurers, including United Healthcare, Oxford, Aetna, Cigna, and several others that are listed on our website. We can help you learn about your options.
We encourage patients to contact Anthem directly to understand fully their continuity of care options and how their plan will cover their treatment if MSK becomes out-of-network. If you have questions about how much your care will cost if processed through out-of-network benefits or are concerned about the cost of your care, please contact our Patient Financial Services team at 646-227-3378 or message the team through the patient portal, my.MSKCC.org. You can also go to MSK.org/financial-assistance for more information.
See a list of the many other insurance plans that include MSK as an in-network provider.
Questions and Answers about MSK/Anthem Contract Negotiations
Why did MSK and Anthem fail to reach a contract renewal agreement?
We’ve been doing everything we can to finalize a new agreement with Anthem Blue Cross Blue Shield New York for months. Yet, Anthem has refused a reasonable contract that ensures uninterrupted access to MSK’s life-saving cancer care. MSK is one of the top providers of cancer care in the nation with lower overall costs and superior patient outcomes compared to other hospitals in the NYC region. Anthem’s current reimbursement rates for MSK are significantly lower compared to our peers. Despite the evidence and concessions we have offered, we have not been able to come to an agreement with Anthem. As a result, MSK may not be part of Anthem’s network in 2025.
How much of an increase is MSK seeking, and when does it expect to reach an agreement with Anthem?
Price transparency brought to light that MSK’s pay rates have been far below that of its competitors for quite some time, even though MSK is one of the top providers of cancer care in the nation with lower overall costs and superior patient outcomes compared to other hospitals in the NYC region. Anthem’s current reimbursement rates for MSK are significantly lower when compared to our peers. MSK has incurred significant cost increases over the past few years, but our Anthem rates have not kept up. We have been working with Anthem to solve these issues since 2022, and we are doing everything possible to reach a reasonable agreement with Anthem as soon as possible, as the current situation is unsustainable.
How many patients would be affected if the parties do not agree on a new contract?
Approximately 21,000 active patients would be affected should we not reach agreements, which is why we have notified them in advance of open enrollment to ensure they can choose an in-network provider, should they choose.
What can patients do to continue their care at MSK in 2025?
We encourage patients to call Anthem at the number on the back of their insurance card to tell them they want to keep access to MSK. If they receive their insurance through their employer, they can talk with their human resources or benefits department and urge them to contact Anthem.
What will happen to Anthem patients seeking treatment at MSK?
If MSK is removed from Anthem’s network, we expect cancer patients insured with Anthem will see higher costs and a reduced quality of care. MSK is working hard to avoid this and continues to push Anthem to come to the table and agree to a reasonable contract. Ultimately, each patient’s individual situation depends on the type of care they are receiving and the type of insurance plan they have with Anthem.
Can patients get a new insurance plan?
Yes, patients may have the opportunity to switch to a new insurance plan, especially if they are approaching their employer’s open enrollment period. Open enrollment is typically the time when employees can review and make changes to their health insurance coverage. If they’re able to choose a new insurance plan, MSK has relationships with many insurers, including United Healthcare, Oxford, Aetna, Cigna and several other plans that are listed on mskcc.org.
We can help patients learn about their options and select a plan that includes MSK in its network to ensure continued access to our care.
Additionally, if patients experience a qualifying life event — such as a change in household, loss of health insurance, or a change in residence — they may be eligible to enroll in a new insurance plan outside of the open enrollment period. We encourage them to explore their options and select a plan that includes MSK in its network to maintain access to our care.
If patients have questions or need assistance navigating their options, they can call our Patient Financial Services team at 646-227-3378 or message the team through the patient portal, my.MSKCC.org. They can also go to MSK.org/financial-assistance for more information.
Are there other options for MSK patients who are employees of the City of New York?
Yes. MSK is in-network with many plans offered by New York City to its employees. Employees who are currently covered by Anthem can choose a different plan that will ensure continued in-network access to MSK. One low-cost health plan available to city employees is the HIP plan, which includes MSK in its network. We encourage NYC employees with Anthem to talk with their HR or benefits department to learn about the other insurance plans available to them and when they can sign up for them.
When will Anthem’s coverage end?
- MSK will remain in-network with Anthem Blue Cross Blue Shield for everyone through December 31, 2024. Our current contract with Anthem will expire as of January 1, 2025. However, because of New York State’s required 60-day “cooling off” period, the terms of the current contract will be in effect until March 1, 2025.
What should patients do if they have a scheduled treatment at MSK on or after January 1, 2025, when the terms of the contract between MSK and Anthem officially expire?
Patients with Anthem insurance who are in active treatment at MSK before March 1, 2025, will continue to receive care at in-network rates as long as they require treatment.
Beginning on March 1, 2025, all Anthem patients who are new to MSK, as well as former MSK patients with Anthem insurance who are no longer in active treatment and are coming to MSK for follow-up care after March 1, will be billed at the out-of-network rate.
We encourage patients to contact Anthem directly to understand fully their continuity of care options and how their plan will cover their treatment if MSK becomes out-of-network. After speaking with Anthem, patients should also reach out to their MSK care team to discuss next steps in their treatment. If they have questions about how much their care will cost if processed through out-of-network benefits or are concerned about the cost of their care, patients should contact our Patient Financial Services team at 646-227-3378 or message the team through the patient portal, my.MSKCC.org. They can also go to MSK.org/financial-assistance for more information.
Can patients switch to other insurance plans that are in-network with MSK?
Yes, we are proactively reaching out to Anthem patients to inform them of this potential change and the options they have to keep MSK in-network. Patients may consider choosing a different insurance plan if they are able to do so during their employer’s open enrollment period or if they experience a “change in life” event, such as a change in household, loss of health insurance, or change in residence. MSK has partnerships with many insurers, including United Healthcare, Oxford, Aetna, Cigna, and many others that are listed on mskcc.org.
Does the contract termination with Anthem Blue Cross Blue Shield affect other Blue Cross Blue Shield plans, such as Empire, Horizon, or out-of-state Blue Cross Blue Shield plans?
Yes, the termination of our contract with Anthem Blue Cross Blue Shield, formerly known as Empire Blue Cross Blue Shield NY, impacts all services provided in New York for all Blue Cross Blue Shield (BCBS) plans under the Blue Card program. This includes members of out-of-state BCBS plans and Horizon BCBS members who access care in New York.
However, MSK has a separate agreement with Horizon Blue Cross Blue Shield that applies to services provided in New Jersey. In New Jersey, all Horizon BCBS members and all BCBS members with “Blue Card” benefits, including those under Anthem/Empire, will still be able to access care at MSK through our Horizon contract, which is not affected by this termination. Additionally, MSK is contracted with Anthem at our Bergen and Monmouth locations in New Jersey, as these counties are adjacent to New York. For those members with “Blue Card” benefits, Horizon could serve as a fallback option as long as all care and services are provided only in New Jersey.
Will MSK offer any financial assistance to Anthem patients who cannot afford out-of-network rates but want to continue receiving their care at MSK?
MSK is dedicated to supporting patients in navigating their financial options. We encourage those facing financial difficulties to reach out to our Patient Financial Services team at 646-227-3378 ormessage the team through the patient portal, my.MSKCC.org. They can also go to MSK.org/financial-assistance for more information.
Patients may also consider switching to a different insurance plan during their employer’s open enrollment period or after a qualifying life event, such as a change in household, loss of health insurance, or change in residence. MSK has partnerships with many insurers, including United Healthcare, Oxford, Aetna, Cigna, and many others that are listed on mskcc.org. Our priority is to ensure that financial barriers do not prevent our patients from accessing the care they need and deserve.
Who can patients talk with if they are worried about paying for their care at MSK?
If patients are concerned about paying their hospital bills, they can call our Patient Financial Services team at 646-227-3378 or message the team through the patient portal, my.MSKCC.org. They can also learn more at MSK.org/financial-assistance. MSK doctors and other medical staff do not know when someone has asked for help. We will never change how we provide care just because a patient has asked us for financial help.
Who can Anthem patients talk to about their specific situation?
If patients have questions about their plan and keeping access to MSK, they should call Anthem. The phone number is on their insurance card. If they have questions about how much their care will cost if processed through out-of-network benefits, we encourage patients to reach out to our Patient Financial Services team at 646-227-3378 or message the team through the patient portal, my.MSKCC.org. They can also go to MSK.org/financial-assistance for more information.
Is there a possibility that MSK and Anthem will resume negotiations and come to an agreement before the current contract term ends?
Yes, we are doing everything we can to finalize an agreement with Anthem and have been for months. In the past, we’ve similarly been able to reach agreements with insurers prior to the contract terms ending. We will continue to press Anthem to come to the table and ensure their plans provide uninterrupted access to MSK’s life-saving cancer care.
What happens if MSK and Anthem reach an agreement after January 1, 2025?
If an agreement is reached after the contract termination date, we will work to reinstate in-network access as quickly as possible. This would ensure that Anthem patients who are new to MSK after March 1, as well as former MSK patients with Anthem insurance who come to MSK after March 1 for follow-up care, could again receive in-network benefits.
As stated previously, all Anthem patients who are in active treatment at MSK prior to March 1, 2025, will continue to receive treatment at in-network rates as long as treatment is needed.
It is also possible we could agree to an extension that would temporarily extend in-network coverage while a final agreement is reached. MSK will communicate any updates to patients and partners as soon as possible, ensuring that everyone is informed of any changes to their insurance coverage.