Trans surgeries cancelled due to dispute between hospital and health insurance company

The dispute between Mount Sinai and Anthem has led to skyrocketing prices in excess of $100,000, which most patients cannot afford.

By Jane Migliara Brigham

A recent dispute between the New York Hospital ‘Mount Sinai’ and the health insurance company ‘Anthem Blue Cross Blue Shield’ has led to revocation of coverage of all surgeries and other services at the hospital which are insured by Anthem. The fallout has caused the cancellation of hundreds of trans surgeries, as patients are forced to pay bills in excess of $100,000, or else cancel their surgeries.

Mount Sinai is one of the largest providers of trans surgeries and related services in the United States, with 7 surgeons offering bottom surgery alone.

The conflict is over a dispute as to how fast prices from the hospital to the insurer should rise. Anthem claims that Mount Sinai wants to raise prices by 50% over the next 3 years, though Mount Sinai denies this.

Anthem had been allowing some surgeries to take place under continuity of care agreements until March 3, and is allowing for “ongoing or serious treatment” until March 31. However, nothing after that date will be covered.

Since getting trans surgeries often take years from first call to getting on the operating table, and the grace period is far less than that, patients with Anthem insurance have been given an ultimatum: pay the full cost of surgery upfront (typically in excess of $100,000), come back with new insurance, or cancel a surgery they probably planned years ago.

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Naturally, most patients don’t have that much money to pay for a surgery. As a result, their options are either to get an entirely new insurance, or lose their surgery dates.

The result has been utter chaos for the patients involved.

The Needle reached out to a number of people affected, and they detailed how the billing department of Mount Sinai has failed to meaningfully address the problem.

One patient told The Needle how she had Anthem as a primary insurance, and another secondary insurance. Even though that secondary insurance made her eligible for her surgery, the billing department failed to recognize that until her surgery date had already been cancelled. She was eventually able to get a new date in the future, but this would not have been necessary if her hospital and insurance had done their jobs.

This whole cancellation is over how to share the money from the healthcare in question. If healthcare was a right, rather than a thing which people needed to pay to access, none of this would have ever happened.