Natalie Reichel is due for her next cancer therapy in March.
But a contract fight between Mount Sinai Health System in New York City, where she gets care, and Anthem Blue Cross Blue Shield, whose network her insurance uses, has cast doubt on whether she’ll be able to get it on time.
“I am feeling dubious,” said Reichel, 40.
The dispute is about money: Mount Sinai says Anthem owes it more than $450 million in unpaid claims, while Anthem says Mount Sinai is demanding a 50% rate increase. Mount Sinai’s physicians went out of network for most Anthem plans on Jan. 1 after the two sides failed to reach a deal, though its hospitals and facilities remain in network until March 1. Roughly 200,000 Mount Sinai patients have Anthem coverage, according to the hospital system.
For Reichel, it means she’ll need a special exception approved by her insurance — something she says she’s had trouble getting — or may need an entirely new team of specialists just to stay on her treatment schedule.
Natalie Reichel, right, with her wife, Red Faolan. (Courtesy Natalie Reichel)
(Courtesy Natalie Reichel)
Reichel was diagnosed with breast cancer when she was 33 years old. She’s been in remission for about six years and regularly gets hormone-suppressing shots to reduce the risk of the cancer coming back.
“My wife worries a lot about me getting a recurrence, because I was really young and it was really aggressive,” Reichel said.
Hospitals and insurers regularly renegotiate rates, but those discussions are usually handled behind closed doors and are typically resolved before patients feel an impact.
But in recent years, many negotiations have become more fraught, often spilling out into public view as both sides put out statements defending their position. When that happens, it’s usually a bad sign for patients.
Jason Buxbaum, a researcher at Brown University, has been tracking disputes between hospitals and insurers since 2021. From June of that year through May 2025, about 1 in 5 hospitals had at least one public dispute with an insurance company, according to Buxbaum’s preliminary findings. About 8% of the hospitals went out of network for the insurance company they were negotiating with, at least for a time. In total, roughly 500 to 600 public disputes between hospitals and insurers occur each year.
“This has accelerated in recent years,” he said. “There’s definitely a potential for folks to get screwed over.”
The disputes have played out with some of the biggest names in health care. Insurance giant UnitedHealthcare warned members could lose in-network access at NewYork-Presbyterian unless the two sides reached an agreement. The insurer also missed a June 30 deadline with Memorial Sloan Kettering Cancer Center, though a deal was reached the next day. In Southeast Texas, Memorial Hermann Health System and Blue Cross Blue Shield of Texas are currently in contract talks for commercial plans, with an April 1 deadline; Memorial Hermann ended its relationship with the insurer for Medicare Advantage plans on Jan. 1. Last year, Duke Health said it would leave Aetna’s network if it didn’t reach a deal — which it ultimately did weeks later.
Leemore Dafny, a professor of public policy at the Harvard Kennedy School, said rising health care costs are a major reason these disputes are becoming more common.
According to the American Hospital Association, an industry trade group, total hospital expenses grew 5.1% in 2024, significantly outpacing the overall inflation rate of 2.9%. It slowed in 2025, although it remains elevated, the group said.
“Hospital prices have grown tremendously,” Dafny said. “So you can imagine that the pushback from insurers against requests or demands for payment increases is going to be pretty fixed.”
Insurers have tried to use tools like prior authorization and claim denials to tamp down on health care costs — but have faced growing public blowback over it, Dafny said. Now, she said, many insurers see contract negotiations as one of the few levers they have left.
“So what’s left is let’s try to pay less for things or let’s actually try to potentially exclude high cost providers altogether,” she said. “ It’s [the] job as an insurer to provide access to high quality care and try to keep it affordable. And that might mean not rolling over every time a provider demands a price increase, even if the provider is dealing with rising prices itself.”
Buxbaum said that another factor in the growing number of disputes is recent federal transparency rules that force hospitals and insurers to reveal more about what they charge — and what they’re paid. In the past, hospitals often had a rough sense of what rate a nearby health system was getting from the insurer, but didn’t know for sure, he said.
“Now nobody wants to be the worst paid on the block,” he said.
Dafny said the problem is likely to grow, especially for Medicare Advantage, which now covers well over half of people on Medicare. Medicare Advantage is run by private insurers, rather than the government.
Unlike traditional Medicare — where patients can generally see any provider who accepts it — Medicare Advantage plans typically rely on a smaller network of doctors and hospitals.
“There’s no question that these processes slow things down and people suffer,” she said.
Brent Estes, the chief managed care officer at Mount Sinai and the lead negotiator in the Anthem dispute, said the hospital system is standing its ground. Mount Sinai is open to hammering out a new contract with Anthem — if the insurer is willing to meet its terms.
“It’s not like we can get paid the same forever,” Estes said. “We feel like we’re substantially lower in terms of our payment rates than our academic peers, which puts us in a difficult position to compete in the market in the long run.”
In an emailed statement, an Anthem spokesperson said the insurer’s sticking point is cost.
“Mount Sinai is seeking price increases and the removal of patient overbilling protections that would drive healthcare costs up by as much as 50 percent by 2028 — far outpacing inflation,” the statement read. “Those costs would ultimately be paid by patients, unions, employers, and governments.”
The spokesperson said Anthem doesn’t have the authority to grant Reichel so-called continuity of care approval. (Reichel’s insurance is administered by International Benefits Administrators, a third party group that uses Anthem’s provider network.) The exception can allow patients to keep seeing their doctors temporarily even after they go out of network.
Reichel said she is working on getting that approval from her insurer.
In the meantime, Reichel said her providers gave her a three-month injection of her treatment at the end of last year because they worried she could face delays once they went out of network.
She doesn’t think a deal will be reached by the time she needs her next one.
“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 said.
This article was originally published on NBCNews.com
