When Coverage Breaks Down: The Hidden Costs of Insurance Disputes
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.
00:00:00:01 - 00:00:27:03
Leslie Schlachter
Hello and welcome back to the vitals, the Mount Sinai Health System's groundbreaking roundtable video podcast. I'm your host, Leslie Schlatter, a neurosurgery physician assistant, here at the Mount Sinai Hospital. On this special edition of our show, we're going to discuss the role of insurance companies in health care and in hospital systems like ours. Specifically, we're going to delve into the ongoing negotiations between Mount Sinai and Anthem Blue Cross Blue Shield to walk us through the facts on the ground.
00:00:27:04 - 00:00:44:16
Leslie Schlachter
We're joined by Doctor Alan Adler, a practicing ObGyn here at the Mount Sinai Hospital, and he's also the senior director for physician contracting and billing. Doctor Adler, thanks for being here. Let's get this started.
00:00:44:18 - 00:01:02:28
Leslie Schlachter
How did we get here? Like I, I want the listeners to know because, like, I'm sure there's a lot of people listening that have anthem. And for someone who practices, I see dozens of patients every week. We operate on patients with anthem, and I'm losing my like, I'm losing my patients. I'm losing my patients and my patients. Absolutely.
00:01:02:28 - 00:01:16:13
Leslie Schlachter
Because I have I have a right now I have a patient on my schedule for the first week of April. We've tried to get a continuity of care. We can't. I have to move the surgery up. I have to move things around. This is so chaotic. How did we get here?
00:01:16:16 - 00:01:35:15
Dr. Alan Adler
So in a nutshell, we try to engage anthem, you know, in specific. And then we had other negotiations with all of three other majors, and we were able to come to agreements over the past two years. Anthem. We knew that the contract ended December 31st, so we tried to engage them. June they were not engaged without.
00:01:35:16 - 00:01:38:25
Leslie Schlachter
Meeting engage outside of just like your normal monthly one hour meetings.
00:01:38:28 - 00:01:59:29
Dr. Alan Adler
No, our contracting team tried to engage them to develop a new contract before it expires December 31st. They would not agree to meet with us. We started to meet with them in August, and we made some headway until about Thanksgiving. At Thanksgiving, they inexplicably just said, we're not doing anything we agreed to and we're not talking to you anymore.