Last Updated
Memorial Sloan Kettering Cancer Center (MSK) has long been recognized as a leader in cancer care, consistently delivering superior patient outcomes while maintaining some of the lowest Anthem reimbursement rates among National Cancer Institute (NCI)-designated hospitals in New York. Despite months of good-faith efforts on our part, Anthem continues to refuse to reimburse MSK at rates that are comparable to those paid to other New York City academic hospitals. The low reimbursement rates we have endured for years are not sustainable for our health system or the world-class care we deliver every single day.
We are negotiating for a new agreement to protect in-network access to MSK for Anthem members with commercial (employer-sponsored) benefits; but you should know that Anthem has selected to drop MSK from its Medicare Advantage network in 2025. Both agreements with Anthem end effective January 1, 2025; however, New York State’s cooling off period allows current patients, regardless of their treatment status, to continue to receive care at in-network rates until March 1, 2025. Active patients who are undergoing ongoing treatment may qualify for Continuity of Care to maintain their in-plan coverage for treatment at MSK beyond March 1, 2025.
At MSK, our priority is ensuring you have access to the best possible cancer care. MSK is recognized as a leader in cancer care, delivering superior patient outcomes while maintaining some of the lowest Anthem rates among National Cancer Institute (NCI)-designated hospitals in New York. Here are a few key points to consider:
- MSK is at the forefront of bringing new drugs and therapeutics to cancer patients, more than any other program in the region—or the country. This extensive range of treatment options, combined with precise initial diagnosis and care, can improve survival rates by up to 70%, depending on the cancer stage.
- Despite delivering superior care and outcomes, Anthem reimburses MSK 34% less than other NCI-designated cancer centers in Manhattan. Even with the rates we proposed to sustain our high-quality care, MSK would still be reimbursed 10.4% less than other institutions, positioning us as the most cost-effective provider of superior cancer care in the region.
- We continuously work to control costs through measures like reducing pharmacy supply expenses, optimizing lab operations, and have even reduced our workforce. However, Anthem’s current reimbursement rates are simply not sustainable. Payment increases are essential to maintain the high level of care we provide to our patients, ensuring continued access to world-class cancer care.
What Patients Need to Know
- MSK will remain in-network with Anthem through December 31, 2024. However, because of New York State’s required 60-day “cooling off” period, current patients will continue to receive care at in-network rates until March 1, 2025. This cooling off period applies to patients with Anthem commercial and Medicare Advantage coverage.
- Despite months of back-and-forth, we do not yet have a new agreement in place to cover commercial patients with Anthem insurance. We are negotiating in good faith despite Anthem dropping us from its Medicare Advantage network for next year, which removes MSK as an in-network provider for patients with Anthem Medicare Advantage benefits and those dually-enrolled in a Medicare/Medicaid plan through Anthem.
- MSK has mailed a letter to our patients with Anthem insurance to update them on potential changes to their coverage. Patients will receive a separate notification from Anthem or their Blue Cross plan detailing when their coverage will change.
- Patients with out-of-network benefits through Anthem can still access MSK in accordance with the terms of their benefits.
- We encourage patients to contact Anthem directly to fully understand their 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. You can also go to MSK.org/financial-assistance for more information.
While we remain committed to reaching a fair agreement, we believe it’s important to give affected patients advance notice of this potential change in their coverage so they can explore other options, particularly during the open enrollment period.
- If you have Anthem health insurance coverage through an employer-sponsored plan, you may be able to select an alternative health plan that keeps MSK in your 2025 network during your company’s upcoming open enrollment period.
- If you are covered by an Anthem Medicare Advantage plan, you can consider switching to a new health plan that keeps MSK in your 2025 network. Open enrollment begins October 15 and runs through December 7, 2024.
- If you have Medicare/Medicaid dual-eligibility, you may also be eligible to make changes in your health insurance coverage for 2025 by speaking with a trusted insurance broker or calling 1-800-MEDICARE.
- MSK has relationships with many other insurance providers, including United Healthcare, Oxford, Aetna, Cigna, and several others. A full list of these plans can be found on the Insurance Plans page of our website. We can help you learn about your options.
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?
- While our agreement with Anthem ends effective January 1, 2025, patients with affected Anthem insurance plans may continue to receive care at in-network rates until March 1, 2025 due to New York State’s required “cooling off” period. Active patients who are undergoing ongoing treatment may qualify for Continuity of Care to maintain their in-plan coverage for treatment at MSK beyond March 1, 2025.
- 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.
- MSK cannot interpret our patients’ health benefits. We encourage patients to contact Anthem directly to understand fully their out-of-network benefits. 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. They can also go to MSK.org/financial-assistance for more information.
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?
Anthem has selected to exclude MSK from its Medicare Advantage network next year. For our commercial patients, we’ve been doing everything we can to reach a new agreement with Anthem Blue Cross Blue Shield New York for months. Yet, Anthem is refusing to pay MSK commensurate rates and has underpaid for MSK’s services for years compared to other providers. This is despite MSK being the most cost-effective cancer care provider, the #1 cancer center in the Northeast, and consistently ranked as one of the top two cancer centers in America for the past 35 years.
Anthem is proposing exceptionally low reimbursement rates that are simply unsustainable and do not reflect the true cost of providing the world-class care that our patients deserve. Currently, MSK’s Anthem reimbursement rates are 34% lower than those of other NCI-designated cancer centers in Manhattan. Even with the rates MSK has proposed to Anthem, we would still be reimbursed 10.4% less than other NCI-designated hospitals, positioning MSK as the cost-effective provider of superior cancer care. Despite the evidence and concessions we have offered, we have not been able to come to an agreement with Anthem.
What will happen to Anthem patients seeking treatment at MSK?
If MSK is removed from Anthem’s network, cancer patients insured by Anthem may face higher costs and a reduced quality of care. MSK is actively working to avoid this outcome and continues to urge Anthem to agree to a fair and reasonable commercial contract that brings it closer to parity with other NCI-designated hospitals in New York. The impact on each patient will ultimately depend on their specific situation, the type of care they are receiving, and the insurance plan they have with Anthem.
Patients with Anthem Medicare Advantage and dual-eligible benefits will not have in-network access to MSK in 2025, because Anthem selected to drop us from their network next year. To avoid higher costs when seeking care with MSK, these patients should consider switching health plans during the upcoming open enrollment period, beginning October 15 - December 7, 2024.
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. If they’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 how their plan will cover their treatment if MSK becomes out-of-network. If patients 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, they can contact MSK’s Patient Financial Services team at 646-227-3378 or visit MSK.org/financial-assistance for more information. Patients should also reach out to their MSK care team, who can provide guidance and options.
How do MSK and Anthem define “active treatment”?
A patient is in “active treatment” if they are still undergoing a course of treatment at MSK. A course of treatment is complete when the planned treatment protocol aimed at combating a person’s cancer has been fully administered and the patient is clinically stable. MSK and Anthem have agreed that “clinical stability” shall mean 90 days have passed since the treatment was fully administered and: a) the patient shows the intended result from the treatment protocol without complications that would require ongoing management by MSK physicians, or b) the patient is receiving maintenance treatment to control or prevent cancer from recurring.
Anthem has acknowledged that there will be situations where clinical collaboration will be needed to treat a patient that are not accurately described by the Course of Treatment definition above. In those cases, providers can utilize the Continuity of Care exception process to have those cases reviewed.
Can patients get a new insurance plan?
Commercial Patients: Yes, patients may have the opportunity to switch to a different 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.
Medicare Advantage, Dual-Eligible Patients: Patients with Anthem Medicare Advantage and dual-eligible benefits will not have in-network access to MSK in 2025, because Anthem selected to drop us from their network next year. To avoid higher costs when seeking care with MSK, these patients should consider switching health plans during the upcoming open enrollment period, which is from October 15 through December 7, 2024.
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 contact our Patient Financial Services team at 646-227-3378 or visit MSK.org/financial-assistance for more information.
Are there other options for MSK patients who are employees of the City of New York?
MSK is in-network with many plans offered by New York City to its employees. However, for some employees, Anthem may be the only available option. We encourage NYC employees who are currently covered by Anthem to consult with their HR or benefits department to understand all insurance options, including when they may be able to choose a different plan that will ensure continued in-network access to MSK. For employees who have alternative choices, the HIP plan is a low-cost option that includes MSK in its network.
We also encourage patients to speak with their human resources (HR) or benefits department and ask them to support keeping MSK in-network with Anthem by advocating for fair reimbursement rates.
When Coverage Ends
When will Anthem’s coverage end?
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. Active patients who are undergoing ongoing treatment may qualify for Continuity of Care to maintain their in-plan coverage for treatment at MSK beyond March 1, 2025. We are committed to ensuring that patients can continue their treatment without interruption during this period.
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?
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. Active patients who are undergoing ongoing treatment may qualify for Continuity of Care to maintain their in-plan coverage for treatment at MSK beyond March 1, 2025. 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 on or after March 1, will be billed at the out-of-network rate.
We encourage patients to contact Anthem directly to understand how their plan will cover their treatment if MSK becomes out-of-network. Patients should also reach out to their MSK care team, who can provide guidance and discuss options. Patients with questions about costs or who need financial assistance may contact our Patient Financial Services team at 646-227-3378 or they can visit 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.
Patients with Anthem Medicare Advantage and dual-eligible benefits will not have in-network access to MSK in 2025, because Anthem selected to drop us from their network next year. To avoid higher costs when seeking care with MSK, these patients should consider switching health plans during the upcoming open enrollment period, which runs from October 15 through December 7, 2024.
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.
What will happen to Medicare Advantage patients?
Medicare Advantage patients and Anthem BCBS patients are covered under separate contracts. Anthem has decided not to renew their contract with MSK for Medicare Advantage patients, regardless of whether we reach an agreement for our commercial patients.
We encourage Medicare Advantage patients currently covered by Anthem BCBS HP (Health Plus) to switch to a new insurance plan. 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.
If patients have questions or need assistance navigating their options, they can contact our Patient Financial Services team at 646-227-3378 or visit MSK.org/financial-assistance for more information.
Cost
Anthem says that MSK’s requested pricing is too high. How do you respond to that?
Currently, MSK’s Anthem reimbursement rates are 34% lower than those of other NCI-designated cancer centers in Manhattan. Even with the rates MSK has proposed to Anthem, we would still be reimbursed at 10.4% less than other NCI-designated hospitals, positioning MSK as the cost-effective provider of superior cancer care. MSK has long been a leader in cancer care, delivering superior patient outcomes while maintaining some of the lowest Anthem rates among National Cancer Institute (NCI)-designated hospitals in New York. However, it has become unsustainable for us to continue providing the level and quality of patient services under the exceptionally low reimbursement structure Anthem is proposing.
MSK has done everything possible and continuously works to drive down costs—from reducing pharmacy supply expenses to optimizing lab operations and even reducing our workforce. Despite these efforts, the costs of delivering high-quality cancer care under the proposed Anthem rates are simply not sustainable. Anthem is fully aware of these increases, yet they pay substantially higher rates to other New York institutions.
As we continue our negotiations with Anthem, it is crucial to recognize that our proposed rate adjustments are necessary to maintain the level of care and service that our patients deserve and bring us closer to parity with other institutions in the New York market. Competitive compensation for our superior services enables MSK to continue investing in our mission to end cancer for life and benefit the communities we serve.
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 or visit 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.
How much is MSK seeking to increase reimbursement rates from Anthem? How does this compare to other NYC academic hospitals?
MSK is seeking fair and competitive compensation for our superior services, enabling us to continue investing in our mission to end cancer for life and benefit the communities we serve.
Currently, MSK’s Anthem reimbursement rates are 34% lower than those of other NCI-designated cancer centers in Manhattan. Even with the rates MSK has proposed to Anthem, we would still be reimbursed at 10.4% less than other NCI-designated hospitals, positioning MSK as the cost-effective provider of superior cancer care.
As we continue our negotiations with Anthem, it is crucial to recognize that our proposed rate adjustments are necessary to close the parity gap and maintain the high level of service and care our patients deserve.
Is MSK doing anything to keep its pricing down?
MSK continuously works to drive down costs—from reducing pharmacy supply expenses to optimizing lab operations and we have even reduced our workforce. Despite these efforts, the costs of delivering high-quality cancer care under the proposed Anthem rates are simply not sustainable. Our precise, innovative, and effective treatments reduce the need for repeat visits and additional interventions. Even in cases where some individual procedures might be priced higher, the overall cost of patient cancer care at MSK is far more cost-effective for Anthem and payors.
As we continue our negotiations with Anthem, it is crucial to recognize that our proposed rate adjustments are necessary to maintain the level of service and care that our patients 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 contact our Patient Financial Services team at 646-227-3378. 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.
Further Questions or Concerns
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 visit 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 a new commercial 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 for patients with commercial health benefits. 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.