A new report analyzing healthcare spending trends within New York City’s employee health plan says there are significant gaps in data because Anthem Blue Cross reportedly refused to release complete pricing information.
New York City spends more than $11 billion annually on health benefits for 1.2 million employees, retirees, and their dependents. About 75% of these individuals are covered through a PPO program administered by Anthem Blue Cross for hospital coverage and EmblemHealth for medical coverage, while another 20% are enrolled in an HMO plan also administered by EmblemHealth. Anthem’s contract with the city is worth about $3 billion annually.
The new report was published March 21 and analyzed claims data for the city’s health plan, but noted that a comparison of hospital procedure costs compared to Medicare rates could not be included in the report because Anthem, part of Elevance Health, did not provide the necessary data on the basis of it not being publicly available. In a statement shared with Becker’s, the insurer disputed that it did not provide the requested information.
“In support of the City’s transparency goals, Anthem provided the comprehensive pricing data that was requested and required under local law,” a spokesperson for the company said. “This data served as the foundation for the report released by the Office of Healthcare Accountability, including detailed breakdowns of medical spend by facility, region, and procedure.”
“The report also includes Medicare-equivalent benchmarks. While Anthem did not submit those calculations directly, the information was included using publicly available data. As noted in the report’s methodology, Turquoise Health generated these benchmarks by analyzing machine-readable files published by hospitals and, where needed, supplemented with data from payer-published files — such as those Anthem makes publicly available in compliance with federal transparency regulations. We strongly support open access to data that promotes informed decision-making, responsible healthcare spending, and systemwide accountability.”
Although the report says its conclusions are not based on complete pricing data, it does provide insights into other aspects of the city’s healthcare spending.
For the top 10 hospital systems in the city for fiscal year 2024, the average amount spent per hospital admission (including medical, surgical, and mental health/substance use treatments) was $45,150. The most expensive hospitals include New York-Presbyterian ($92,727), Montefiore ($83,573), Westchester Medical ($74,101), and NYU Langone ($59,271). On the lower end, Stony Brook’s average was $36,876.
Prices for certain services vary significantly across the city’s hospitals. For a colonoscopy, prices can range from $940 to $12,000, and for a cesarean section, prices range from $7,000 to $58,000.
“Anthem Blue Cross and Blue Shield in New York is proud of our long-standing, collaborative partnership with the City of New York. We remain deeply committed to delivering affordable, high-quality healthcare for City employees, retirees, and their families — and to working with our partners in labor, government, and across the healthcare system to promote transparency and long-term sustainability,” the company said in its statement. “We will continue to work constructively with the City of New York, organized labor, and healthcare providers to advance value-based care, fair pricing, and greater transparency — always with the goal of improving outcomes and affordability for the people we serve.”
