Mount Sinai, Anthem Blue Cross Blue Shield contract dispute could force thousands to find new doctors

If Mount Sinai and Anthem Blue Cross Blue Shield don't reach an agreement this month, thousands of patients will be forced to either pay a hefty price for care or find new doctors elsewhere.

Mount Sinai and Anthem Blue Cross Blue Shield failed to reach a contract agreement by Dec. 31, which means about 9,000 Mount Sinai physicians are no longer considered in-network.  

Negotiations hit roadblock

State law requires the hospital to remain in network until March 1.

"We have about 200,000 unique Anthem patients that seek care from a provider at Mount Sinai on an annual basis," said Brent Estes, Mount Sinai Health System's senior vice president and chief managed care officer.

Estes said the renegotiation process began in spring 2025, but hit a roadblock around Thanksgiving.

"Unfortunately, after that weekend, Anthem decided to withdraw all of its offers and proposals off the table, and we've had very little contact with them since that point in time," Estes said.

This means many will be forced to find doctors elsewhere.

A family's struggle for answers

Between Callum DeQuevedo and his father, Chad DeQuevedo, they see a total of 10 Mount Sinai doctors. Now, they are all out of network. 

Callum DeQuevedo struggled for seven months with severe involuntary tics, punching himself and yelling, before anyone knew why this was happening.

The journey to find answers began when Callum DeQuevedo started experiencing trouble breathing at age 13. His parents recorded videos to document the severity.

More than 30 doctors later, he finally got a proper diagnosis:  Tourette syndrome.

"Our heroes are at Mount Sinai," Dawn DeQuevedo said.

In 2022, Callum DeQuevedo underwent a life-altering procedure known as deep brain stimulation surgery, most commonly used for Parkinson's. It uses a pacemaker-like device to send electrical signals to areas of the brain that control movement.

"It has made a difference in his life. Like, I don't know how we would have gotten him to 20 years old," Dawn DeQuevedo said.

"He's told me a few times it totally saved his life," Chad DeQuevedo said.

"It totally saved his life. So, not even a question. But it's not a cure," Dawn DeQuevedo said.

Callum DeQuevedo continues to see several doctors at Mount Sinai.

His father is also a patient after a tumor was discovered on his pituitary gland.

"I just had the surgery back in October to have it removed. And I'm one of the lucky few who, it's back," Chad DeQuevedo said.

Health care confusion

Neurosurgeon Dr. Ted Panov says Callum DeQuevedo's case is a complex one, so it would be challenging to find another team to take it on.

"The idea that now I have to tell patients we can no longer care for them because this is happening, that's incredibly frustrating," Panov said.

The DeQuevedo family said adding to confusion, they are covered by Highmark, a separate Blue Cross Blue Shield plan based out of their home state of Pennsylvania, not Anthem, so it's been difficult to get answers.

"The insurance company and the hospital sent out letters. So one of the things says is that if you are a complex case, you can get a continuity of care. But the hoops that they're putting us through are designed to make us fail," Dawn DeQuevedo said.  

Regarding the DeQuevedo case, Anthem said in a statement:

"Anthem's priority is ensuring that Mt. Sinai patients receive uninterrupted care and understand their options. For members who are in active or ongoing treatment, Continuity of Care protections are designed to help prevent disruption during a network transition.

"In this specific case, the family interviewed is covered by Highmark, a separate Blue Cross Blue Shield plan based in Pennsylvania. Coverage decisions beyond regulatory requirements, including Continuity of Care determinations, are made by a member's home plan. Anthem does not have the authority to make those determinations for members insured by other Blue plans.

"That said, we are actively helping connect the family with the appropriate team at Highmark so they can receive guidance on next steps and ensure their care continues without interruption. Our focus remains on supporting patients and helping them navigate the process as smoothly as possible."

After CBS News New York reached out, Anthem connected with the Highmark team, who said in-network care will continue for now for the DeQuevedos. 

In a statement, Highmark said:

"Both Chad and Callum DeQuevado have been approved by Highmark for continuation of care with the doctors they have been seeing at Mt. Sinai. The continuation of care is for 90 days beyond the termination date with Anthem. However, the Mt. Sinai physicians can request a single case agreement or gap exception to extend the continuation of coverage by contacting Highmark. Just yesterday (Feb. 3), Callum's continuation of care request for Mt. Sinai West hospital was approved and completed and the request for Chad has been submitted and is pending completion."

The family argues they've heard that before.

"There's people that I think are giving up. And then what does that mean for the care ... for themselves or their loved one?" Dawn DeQuevedo said.