The HR playbook for managing insurer-provider disputes

Breaking up is hard to do—especially when the split isn’t on your terms.

On Jan. 1, 2026, New Yorkers enrolled in Anthem Blue Cross Blue Shield health plans received news that their insurer had broken up with Mount Sinai, one of the largest hospital systems in the US.

In an open letter, Anthem said it failed to reach a contract in negotiations with the provider network. As a result, members seeing any of Mount Sinai’s roughly 9,000 doctors no longer have insurance coverage for these providers. Coverage for the health system’s hospitals, outpatient centers, and other facilities is set to end on March 1, though experts say the two sides could still reach an agreement before then, or further down the road.

This isn’t the first time Mount Sinai has dropped coverage for patients enrolled in certain health plans. Tens of thousands of patients on UnitedHealthcare and Oxford health plans were forced out of network in 2024 due to a dispute between the insurer and Mount Sinai. Ongoing negotiations between United Healthcare and New York-Presbyterian have raised the possibility of coverage losses among patients with that New York City-based health system, as well.

These occurrences aren’t limited to New York. Eighteen percent of non-federal hospitals across the US fought publicly with an insurance company between June 2021 and May 2025, while 8% of these hospitals went out of network with an insurer, at least temporarily, according to research from Jason Buxbaum, a health policy researcher with Brown University’s School of Health.

These disruptions are a reflection of the current healthcare market, industry experts told HR Brew. As health costs continue to rise, both insurers and employers are looking for ways to cut back on expenses. Strategic communication is key, though, when workers are affected by such disruptions, they added.

What’s driving some providers out of health plan networks? In recent years the cost of healthcare has risen as providers have consolidated, but health plans have been reluctant to negotiate over fear of disrupting patient care, said Caroline Pearson, executive director of the Peterson Health Technology Institute.

Employers, too, she noted, have harbored this same fear of disrupting workers’ healthcare.

That environment appears to be shifting though, as both health plans and plan sponsors grapple with sky-high expenses. Employers are expected to see health benefit costs jump 9% this year if they don’t do anything to control them, according to surveys from Mercer and Business Group on Health.

Pearson observed a “focus on cost and a demand to manage premiums that is empowering the health plans to push back a bit more…and the unfortunate temporary result of that is that actually you end up with either providers getting kicked out of networks, or just temporary periods in which they are…not available to to patients.”

Edward Kaplan, a national health practice leader with Segal whose clients include employers, said he’s observed a similar trend.

“We’re back in the cycle of clients willing to trade choice of network providers for better pricing,” he said. Kaplan said employers are generally reluctant to push for choices that disrupt patients, but he said they have a limited set of tools available to control costs, especially if they want to avoid passing on additional expenses to their workers.

Managing change. As with any change to employee benefits, communication is key when health plans go out of network with providers, Kaplan said.

At the bare minimum, HR teams should make sure that their insurer is reaching out to employees to inform them of potential changes due to contract disputes, he said. They may also be able to direct employees to resources from the health plan that allow them to research providers that will remain in-network.

Employees should also be aware of any laws that guarantee continuation of care for certain patients. In New York, patients who have a serious or complex condition, are scheduled for nonelective surgery, or are receiving treatment for a terminal illness, can all continue to receive coverage for a provider who leaves their network for 90 days, for example. This same rule applies to pregnant patients until the end of postpartum care.

In recent years employers have gotten better at explaining the rationale behind decisions affecting workers’ health benefits, Kaplan observed. “Employees want options. They understand there’s a trade off between affordability and choice and cost of care.”

Employers “that have succeeded” in this area “have spent energy on a communications plan that both explains to workers what the changes are and the rationale for those changes, but then critically returns benefit to the workers that are tied to those changes,” Pearson said. If employers can find ways to reduce cost-sharing, for example, workers may better understand how they’re benefiting from changes to their health plans, too.