Insurance Coverage Update: Mount Sinai and Anthem / Blue Cross Blue Shield / Empire
What’s Happening
Tia works with a major health system in each market; the health system negotiates payor contracts on behalf of Tia. Sometimes, health systems and payors go through renegotiation processes that take longer than expected. This is currently the case between Mount Sinai in NYC and Anthem / Blue Cross Blue Shield / Empire.
Currently, the contract between Mount Sinai and Anthem / Blue Cross / Empire is set to expire on 03/01/26.
Historically, when we’ve seen this happen, the health system and the payor always come to an agreement – but it can mean that there is a period where coverage is interrupted.
What This Means for Patients
For existing patients at Tia
For existing patients at Tia - if you established care with Tia before 03/01/26 then Anthem / Blue Cross / Empire is likely to honor your coverage, and we do recommend continuing your care as you need. However, please note there will be a delay in the claims associated with your visits during this period. Your visits cannot be billed to insurance until the health system and payor reach an agreement and contracts are reinstated – this could mean several months of delays for your EOBs and bills from Tia.
For new patients
For new patients - If you have not established care at Tia before 03/01/26 and hold an Anthem / Blue Cross / Empire you are unlikely to be covered as in-network for your visits. Your visit will likely be processed as out-of-network during this period of renegotiation. We recommend reviewing your out-of-network coverage and benefits before visiting Tia. Tia will, of course, still see you during this phase of renegotiations, and if there is an urgent need, we do recommend you come. If you have large out-of-pocket costs associated with out-of-network coverage, our predictable payments program can help. Please read about this program here. Feel free to contact a care coordinator to discuss details of your care and coverage if you have questions.
Timeline & Ongoing Updates
We anticipate this coverage lapse will not exceed 6-8 weeks. However, if it does, or if we receive new information about this process, we will reach out and update this webpage.
Questions About Your Coverage?
If you have questions about how this may impact your care or insurance coverage, you can speak with a member of our Engagement Team.