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Memorial Sloan Kettering Cancer Center (MSK), has long been recognized as a leader in cancer care, consistently delivering superior patient outcomes while doing our part to deliver cost-efficient cancer care to every patient we serve. While MSK continues to seek a fair agreement that will keep services in network for Anthem members, Anthem has not reciprocated this effort. We continue to implore Anthem to put the needs of our patients first and reach a fair agreement.
At this time, we are not confident that a deal will be reached before our contract expires on January 1, 2025. Anthem continues to stall negotiations and refuses to make any effort to provide MSK with adequate reimbursement.
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. Anthem will force MSK out-of-network if they continue to refuse to pay rates that reflect the true cost of providing the world-class care our patients deserve.
Important Information for Patients with Anthem Blue Cross Blue Shield Coverage
While this will ensure that patients can continue to access in-network care at MSK, it does not mean we have a contractual agreement with Anthem that allows for longer-term in-network access to care.
At MSK, our priority is ensuring you have access to the best possible cancer care.
- 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 have proposed to sustain our high-quality care, MSK would still be reimbursed more than 10% less than other NCI-Designated Cancer Centers in Manhattan, solidifying our position as the most cost-effective provider of top-tier cancer care in the region.
- We work continuously to control costs through measures like reducing pharmacy supply expenses and optimizing lab operations and have even reduced our workforce. However, Anthem’s current reimbursement rates are simply not sustainable. Anthem’s refusal to pay MSK rates comparable to those they pay other hospitals makes it exceptionally difficult for MSK to maintain the superior — often life-saving — treatments that patients rely on for improved health outcomes.
What Patients Need to Know
Our primary focus remains on ensuring that our patients have uninterrupted access to MSK — this is the goal at the heart of our negotiations with Anthem. Still, we must prepare for the possibility that Anthem will allow our contract to expire on January 1.
For All Active Patients:
- Extended In-Network Access to MSK: Our agreement with Anthem ends effective January 1, 2025. However, New York State’s cooling-off period allows current and new patients, regardless of their treatment status, to continue to receive care at in-network rates until March 1, 2025.
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Continuity of Care: Active patients who are undergoing treatment will qualify for Continuity of Care, which will maintain their in-plan coverage for the duration of their treatment at MSK. MSK will oversee this continuing benefit on behalf of our eligible patients; patients do not need to take any action.
- While this will ensure that patients can continue to access in-network care at MSK, it does not mean we have a contractual agreement with Anthem that allows for longer-term in-network access to care.
For Former Patients (No Longer in Active Treatment):
- Patients who are no longer in active treatment are still eligible for in-network follow-up care at MSK until April 1, 2025. This is due to New York State and federal law, which requires that health insurers offer a 90-day period for transitional care following a disruption in in-network coverage.
For Anthem Medicare and Medicaid Patients:
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Anthem has made the decision to exclude MSK from its Medicare Advantage network in 2025. Beginning on January 1, 2025, Anthem will no longer include MSK as an in-network provider for Medicare Advantage patients. However, these patients can continue to access MSK at in-network rates until March 1, in line with New York State’s mandatory cooling-off period.
- If they are in active treatment, Medicare Advantage patients are also eligible for Continuity of Care, which provides access to in-network care at MSK for the duration of their treatment, beyond March 1, 2025.
- In addition, Medicare Advantage patients can change their health plan during Open Enrollment, which runs from January 1 to March 31, 2025. During this period, these patients can choose a different health plan that includes MSK as an in-network provider. Patients interested in changing their health plan during Open Enrollment should visit the Medicare website or call 1-800-MEDICARE (800-633-4227).
- Patients with Medicare Fee for Service as their primary health insurance, who have a Blue Cross Blue Shield or Anthem BCBS Medicare supplemental policy, are not impacted by the Anthem contract termination with MSK. MSK’s contract with Anthem does not include Medicare Supplemental policies, which are governed by Medicare benefits.
- Patients with the Anthem HealthPlus Medicaid plan are not impacted. Patients with this plan will not lose their in-network coverage in 2025 regardless of the outcome of MSK’s contract negotiations with Anthem.
For patients with Anthem coverage through their employer (commercially insured patients):
- Keep Scheduling Appointments: Patients with Anthem commercial health plans should continue to schedule care at MSK. In-network coverage will remain in place until at least March 1, 2025, regardless of our contract status with Anthem.
- Out-of-Network: 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 (by calling the number on the back of their insurance card) to learn more about their out-of-network benefits.
- Communication: MSK has mailed letters 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.
- If you have questions about your care, contact MSK directly: MSK’s top priority is providing our patients with the life-saving cancer care they need and deserve. If you have any 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.
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 that are listed on our website. We can help you learn about your options.
If you 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.
See a list of the many other insurance plans that include MSK as an in-network provider.
MSK/Anthem Contract Negotiations Questions and Answers
Why haven’t MSK and Anthem reached a new agreement yet?
For years, Anthem has underpaid MSK for the superior cancer care we deliver, despite MSK being the #1 cancer care provider in the Northeast and consistently ranked as one of the top two cancer centers in the United States for the past 35 years. Anthem’s payment to MSK does not reflect the true cost of providing the high-quality cancer care patients deserve. Currently, Anthem pays MSK at rates that are 34% lower than those of other NCI-Designated Cancer Centers in Manhattan.
Continuing to accept low payments from Anthem would threaten MSK’s ability to provide world-class care. While MSK continues to seek a fair agreement that will keep services in network for Anthem members, Anthem is refusing to negotiate in good faith.
What will happen to Anthem patients seeking treatment at MSK?
If Anthem forces MSK out of its network in 2025, patients with Anthem insurance will be urged to find an alternative in-network cancer care provider. This is a disruptive and time-intensive process in which Anthem will move patients to higher-cost in-network providers with poorer health outcomes. This is an outcome MSK has been working tirelessly to avoid without reciprocated effort from Anthem.
What can patients do to continue their care at MSK in 2025?
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Contact Anthem and tell them that their position in these negotiations is unacceptable:
- Call the number on the back of your insurance card to encourage Anthem to negotiate in good faith, and request that they keep MSK as an in-network provider.
- Receive Continuity of Care: Patients in active treatment are eligible for Continuity of Care benefits that will extend in-network coverage for ongoing treatment at MSK beyond March 1, 2025. Continuity of Care ensures that Anthem will continue to cover planned treatment until it has been fully administered and a patient is considered clinically stable. If you are in active treatment, MSK will inform Anthem that you qualify for Continuity of Care — no action is required of you.
- Speak with your HR department: If your insurance is provided through your employer, you should speak with your human resources (HR) or benefits department and ask them to support keeping MSK in-network with Anthem. If you selected an Anthem insurance benefit for 2025, your monthly premiums were calculated by Anthem to include in-network access to MSK. If MSK is forced out of network, your premiums remain the same.
- If you have questions about your care, contact MSK directly: MSK’s top priority is providing our patients with the life-saving cancer care they need and deserve. If you have any 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.
How do MSK and Anthem define “active treatment” for Continuity of Care?
A patient is in “active treatment” if they are still undergoing a course of treatment at MSK when disruption occurs on March 1, 2025. A course of treatment is considered complete when the planned treatment protocol aimed at combating a person’s cancer has been fully administered and the patient is clinically stable.*
*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.
Can patients get a new insurance plan?
- Patients who experience a qualifying life event — such as a change in household, loss of health insurance, or a change in residence — may be eligible to enroll in a new insurance plan outside of their employer’s open enrollment period.
- Medicare Advantage patients can change their health plan during Open Enrollment, which runs from January 1 to March 31, 2025. During this period, these patients can choose a different health plan that includes MSK as an in-network provider. Patients interested in changing their health plan during Open Enrollment should visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227).
If you have questions or need assistance navigating your options, contact our Patient Financial Services team at 646-227-3378 or visit MSK.org/financial-assistance for more information.
When Coverage Ends
When will Anthem’s coverage end?
Our existing agreement with Anthem ends effective January 1, 2025. However, because of New York State’s required 60-day cooling off period, all current patients, regardless of their treatment status, will continue to receive care at in-network rates until March 1, 2025.
- While there is a period of prolonged access to in-network care at MSK as a result of the cooling- off period, it does not mean we have a contractual agreement with Anthem that will maintain in-network access to care beyond March 1.
- We have also confirmed with Anthem that active patients who are undergoing ongoing treatment will qualify for Continuity of Care to maintain their in-plan coverage for treatment at MSK beyond March 1, 2025. MSK will oversee this continuing benefit on behalf of our eligible patients; patients do not need to take any action.
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?
New York State’s required 60-day cooling off period enables all current patients, regardless of their treatment status, to continue to receive care at in-network rates until March 1, 2025. While there is a period of prolonged access to in-network care at MSK as a result of the cooling-off period, it does not mean we have a contractual agreement with Anthem that will maintain in-network access to care beyond March 1.
Beginning on March 1, 2025, Anthem patients who are new to MSK will no longer have in-network coverage from Anthem and 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 is forced out-of-network. 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.
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, if Anthem allows our contract to expire, this will impact all services provided in New York for all Blue Cross Blue Shield plans under the Blue Card program. This includes members with out-of-state BCBS plans and Horizon BCBS members who access MSK for care in New York.
Horizon BCBS members and BCBS members with “Blue Card” benefits, including those under Anthem/Empire, can still access care at MSK’s New Jersey locations regardless of our status with Anthem in 2025. If MSK is forced out of Anthem’s network, New York patients may consider moving outpatient services to MSK’s Bergen and Monmouth locations in New Jersey to continue receiving in-network access to MSK’s leading cancer care.
What will happen to Anthem Medicare Advantage patients?
Anthem has made the decision to exclude MSK from its Medicare Advantage network in the coming year. Beginning on January 1, 2025, Anthem will no longer include MSK as an in-network provider.
If they are in active treatment, Medicare Advantage patients are eligible for Continuity of Care, which provides access to in-network care at MSK for the duration of their treatment, beyond March 1, 2025.
In addition, Medicare Advantage patients can change their health plan during Open Enrollment, which runs from January 1 to March 31, 2025. During this period, these patients can choose a different health plan that includes MSK as an in-network provider.
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 their payment rates to MSK are the highest on record and that MSK’s requested pricing is too high. How do you respond to that?
Anthem is misleading patients about their reimbursement rates to MSK. In truth, Anthem reimburses MSK at rates that are 34% lower than what Anthem pays other NCI-Designated Cancer Centers in Manhattan. Price transparency data allows us to know this unequivocally. Our reimbursement from Anthem is tied directly to MSK’s ability to invest in innovative treatments and cutting-edge care that cures, heals, and improves people’s lives. Unfortunately, Anthem still refuses to pay us commensurate rates, ignoring the very real financial requirements to deliver best-in-class cancer care.
We don’t want better reimbursement. We need better reimbursement to deliver the very best lifesaving care for patients who experience a cancer diagnosis.
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 that are listed on our Insurance Plans page. 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?
Anthem reimburses MSK at rates that are 34% lower than what Anthem pays other NCI-Designated Cancer Centers in Manhattan. Price transparency data allows us to know this unequivocally. MSK is proud to be the most cost-effective cancer care provider in the region, and we are committed to remaining cost-effective. The rates we have proposed to Anthem ensure we receive the payment increases that are necessary to sustain the high-quality care we deliver, while still being paid 10.4% less than other NCI-Designated hospitals.
Is MSK doing anything to keep its pricing down?
Yes, MSK works continuously to drive down costs through many avenues, including reducing our pharmacy supply expenses, optimizing lab operations, and even reducing our workforce. Despite these diligent efforts, Anthem’s reimbursement does not do enough to cover what it takes to deliver leading cancer care.
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 patients talk to about their specific situation?
- Questions about benefits coverage: Call Anthem via the number on the back of your insurance card.
- Questions about treatment or cost of care: MSK’s top priority is providing our patients with the life-saving cancer care they need and deserve. If you have any 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.
Is there a possibility that MSK and Anthem will come to an agreement before the contract expires on January 1, 2025?
Despite continued efforts, we are not confident that a deal will be reached before our contract expires. As negotiations stand today, Anthem still refuses to pay us commensurate rates and chooses to ignore the very real financial requirements of delivering best-in-class cancer care. We continue to implore Anthem to put the needs of patients first and negotiate in good faith. We will keep our community informed as updates come available.
What happens if MSK and Anthem reach an agreement after January 1, 2025?
We will work to reinstate in-network access as quickly as possible for patients with commercial health benefits. 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.