Health
Negotiations Between United Healthcare and Montefiore Health System Break Down
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- Written by Joanne Wallenstein
- Category: Health
Many patients in our area have received letters from both United Healthcare and the Montefiore Health system (that includes White Plains Hospital) about their failure to reach an agreement for 2021. As a result, all Montefiore hospitals and physicians are out of network as of January 1, 2021 for employer-sponsored and individual plans, including Oxford, as well as their Medicaid plan, effective Jan. 1, 2021. But consistent with state regulations, members enrolled in fully insured commercial plans and United’s Medicaid plan will continue to have in-network access to Montefiore’s hospitals through Feb. 28, 2021.
Why?
United claims that Montefiore is the city’s most expensive health system and they are demanding a 30% price hike over the next three years. In addition hospital reimbursement rates at Moses and Einstein campuses are higher than any other hospitals in the state. The insurer says, “The demand to increase Montefiore’s already high rates is unreasonable at a time when so many people and employers are struggling and would lead to higher premiums and out of pocket costs.” They say that these rates would require United to pay fees that are five times Medicare reimbursement rates. As Montefiore received more than $1 billion in federal aid during the pandemic United argues these funds should be used to reduce fees for patients.
United Healthcare claims that Montefiore rates are too high.
For its part Montefiore claimed they negotiated in good faith and that “data shows that their reimbursement rates are at or slightly below the average for the top 5 hospitals in the country and comparable academic teaching hospitals in New York…. Montefiore is only asking for reasonable single digit annual increases that are consistent with the rates we receive from every other major insurance company.”
We reached to Lara Markenson, the Director of Public Relations for Montefiore and here are her responses to our questions:
Do you think that Montefiore and United will ultimately reach an agreement?
Our goal is to reach a fair resolution that restores in-network access and prevents further patient disruption. Montefiore had negotiated in good faith since the beginning of July, though United offered little progress, stalled negotiations since November 19, and has refused to respond in good faith to our latest proposal.
Unfortunately, United continues to misrepresent negotiations. Since the beginning, Montefiore has only asked for reasonable single digit annual increases that are consistent with the rates we receive from every other major insurance company.
For patients that are currently insured by United and Oxford, will you take their insurance until February 28?
All Montefiore Physicians are out of network which means patients will not be covered at in-network rates.
Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date may qualify for Continuity of Care through United that would extend your in-network benefits. If you think you may qualify, you should call the phone number on the back of your United health insurance card today to request a Continuity of Care form and apply.
Patients with United Medicare DSNP Community Plans will continue to have in-network access to all Montefiore hospitals and doctors until midnight March 31, 2021.
Patients with United Medicaid Community Plans and United/Oxford Fully Insured Commercial Plans will continue to have in-network access to Montefiore hospitals until midnight March 1, 2021.
Patients with Medicaid can call NYS DOH and ask to change plans to ones that have in-network access to Montefiore doctors and hospitals.
Patients always have in-network access to our emergency rooms, regardless of our status with United. If you experience an emergency, you should always visit the nearest emergency room. Patients needing emergency care are entitled to receive in-network treatment until the patient is stable.
Why do you think this has come to an impasse this year?
Montefiore had negotiated in good faith since the beginning of July, though United offered little progress and stalled negotiations since November 19, refusing to respond to our latest proposal in good faith.
In the final hours of our contract on New Year’s Eve, without even considering our proposal, United asked for an extension that only would have prolonged uncertainty until a time when our communities’ employers and residents would have missed an opportunity to switch to other health plans that would restore in-network access to Montefiore. Once again, Montefiore offered to negotiate in good faith to reach an agreement to prevent disruption of healthcare services, however United declined our offer. We are disappointed by United’s decision to block 60,000 patients from seeing their trusted Montefiore doctors and hospitals while the pandemic continues to surge.
How is Montefiore responding to the insurer’s charge that the hospitals are billing more than other systems in the area?
Rand Corporation data shows that our reimbursement rates are at or slightly below the average for the top 5 hospitals in the country and comparable academic teaching hospitals in New York. Montefiore is only asking for reasonable single digit annual increases that are consistent with the rates we receive from every other major insurance company. Also, despite United's claim that Montefiore received $1 billion, Montefiore actually received $769 million in cares act grant. This was all used for patient care during the COVID pandemic across our 10 hospitals.
If you are not able to reach an agreement, what will patients in our area do?
Patients should look to change their insurance plan if they can or ask their employer to make a change or offer additional health plan options so they can continue to see the Montefiore doctors and use the Montefiore hospitals they know and trust.
Commenting on the problem, Scarsdale resident Judy Hochberg said, ""This dispute affects me and my husband since we regularly see doctors at Scarsdale Medical Group and White Plains Hospital. We are switching back to another insurance plan that costs more but has all of our physicians. Just a few years ago we had to change doctors within SMG because of a contract disagreement with Empire Blue Cross / Blue Shield. These two events are symptomatic of larger problems in our dysfunctional healthcare system, which fails to provide confidence and continuity of care even to consumers who can afford private insurance."
White Plains Hospital Administers its First COVID-19 Vaccines to Hospital Staff
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- Written by Joanne Wallenstein
- Category: Health
White Plains Hospital administered its first COVID-19 vaccines to essential healthcare workers on December 15, 2020. White Plains Mayor Tom Roach joined Hospital leadership at this momentous event as five frontline medical workers were vaccinated, including Respiratory Therapist Brian Benjamin; Betsy Amaya, RN on 4F, Sharia Mohammed, RN in the Emergency Department; Frank Quintero, MD in the Emergency Department; and Kristina Krecko, MD on 4F.
The vaccinations administered today mark a hopeful point in the COVID-19 pandemic in 
Westchester County and New York State. White Plains Hospital is located near the pandemic’s epicenter in Westchester County, and White Plains Hospital has cared for thousands of COVID-19 patients since the beginning of the pandemic.
The Hospital plans to continue to administer vaccinations to its staff over the next several weeks, following guidelines established by the Department of Health.
Thanksgiving Plans Altered But the Holiday Spirit Remains
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- Written by Sydney Piccoli
- Category: Health
The outbreak of the COVID-19 has crafted a new normal that has become our daily reality. Even beloved family traditions that emerge during the holiday seasons, such as devouring pumpkin pancakes early in the morning or playing an annual football game, are not safe from the virus’ path. With Thanksgiving on the horizon, a majority of Scarsdale families now find themselves unsure of how to proceed — still wanting to celebrate the joyous holiday yet also keenly aware of the risks.
Most of the Scarsdale residents understand the dire implications that could result from hosting lavish gatherings in enclosed spaces during a pandemic. Not being able to spend Thanksgiving, a holiday where many find joy in shared time with family and friends, to protect those same individuals is a hard concept to grasp. We’re accustomed to the inviting atmosphere that emerges as loved ones partake in a feast with family favorites like buttery mash potatoes and tart apple pie. In many ways, during a year filled with twists and turns such as this one, Thanksgiving would have served as a pleasant hint of normalcy — a glimmer of life before present-day social-distancing and mask mandates.
However, like everything in this strange year, it is simply not possible. Just as we have had to adjust to learning or working in a different environment, we must make painful adaptations to Thanksgiving plans.
Nevertheless, there are several ways to ameliorate the pain from a modified Thanksgiving. First and foremost, it is important to revisit the meaning of Thanksgiving as a holiday when we express gratitude and give back. As many of us are fortunate enough to have food on our tables, it is always a good idea to pay it forward. For instance, an act of charity could mean picking up a few extra cans of food during a weekly grocery-shop to donate to families who are suffering financially as a result of the pandemic. Another example is to connect with an older adult from an elderly home via Zoom to bring them a little Thanksgiving joy during a hard time.
Fearing the potential repercussions of leaving Thanksgiving plans open for interpretation, Governor Cuomo has made his recommendations clear. He urges fellow New Yorkers to stay home and limit traveling during the holiday season; he believes that if large groups come together for traditional celebrations the spread of the coronavirus will intensify, leading to a spike in cases. Furthermore, according to mandates, individuals are required to limit gatherings to no more than ten people to decrease the chances of a potential COVID-19 outbreak. According to Scarsdale100583’s Thanksgiving survey 93.1% of Scarsdale residents, will comply with Cuomo’s regulations of limiting all indoor gatherings to ten people.
It is important to remember that Cuomo's guidelines were made to ensure the safety of all New Yorkers. To comply, Scarsdale families are crafting Thanksgiving plans that retain some traditions while safeguarding all the people at the table. Most are limiting the number of guests and maintain distance between them. According to our survey, 74% of participants, in a typical year, would have anywhere from 11 to 26+ people at their Thanksgiving table. However, given the pandemic, an overwhelming 94.7% will now be dining with 1 to 10 guests given the current state of the world.
With modified plans in place, some feel safer delving into their Thanksgiving feast. “I’m going to my aunt and uncle's house with just their family and ours. It is a small number of individuals and we will all be eating outside. I’m not too nervous about us because I think we are taking the necessary precautions to ensure our mutual safety,” remarked Ben Spitanly, a junior at Scarsdale High School.
No matter how many alterations Scarsdale residents make though, this year’s Thanksgiving will simply be different from all the rest. “Thanksgiving is so special and even substitutes like Zoom will never be able to replace the memories created by this day. Because Thanksgiving will not be celebrated in person with the rest of my extended family it almost feels surreal...a day once celebrated by 10-20 family members in the past will now be celebrated by three together in person,” added Rowan Haffner, a junior at Scarsdale High School.
As many of us indulge in a smaller yet still meaningful Thanksgiving feast, let it be a reminder to all that the holiday orbits around the idea of being grateful. We should give thanks for the plentiful food that spans our dining room tables, show appreciation for those that remain in our lives, and most importantly, express our deepest condolences to those families who will inevitably have empty seats at their tables. “Thanksgiving is always the one time where I get to see my entire family. Although this year it will be accompanied by Zooms and Facetimes, the holiday, like always, will be about surrounding myself with loved ones and relaying our gratitudes — no matter what form it must take,” concluded Shamolie Panjwani, a junior at Scarsdale High School.
SHS PTA Scholarship Fund Asks for Your Support
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- Written by Joanne Wallenstein
- Category: Health
The Scarsdale High School PTA Scholarship Fund for College helps to defray freshman-year tuition costs for students in need of financial assistance by providing grants to graduating SHS seniors for their freshman year of college.
Every Scarsdale household recently received an appeal to support the Scarsdale High School PTA Scholarship Fund for College. While our community is generally one of means, there are families here affected by hardship, such as illness, divorce, and business collapse, which can have devastating effects on a family’s ability to pay for college education. Due to the current pandemic, we expect student need to be even more significant this year.
The Fund is administered under strict rules of confidence, and all money raised directly benefits qualified students. Scholarship funding comes solely from donations by Scarsdale residents, businesses and organizations.
You can learn more about and donate to the SHS PTA Scholarship Fund for College by clicking here. Donations, which are tax-deductible, may also be mailed to SHS PTA Scholarship Fund for College, P.O Box 147 H, Scarsdale, NY 10583. Please contact Dana Matsushita at dmatsushi@gmail.com with any questions.
Help for Victims of Domestic Violence Available During the COVID-19 Pandemic
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- Written by Joanne Wallenstein
- Category: Health
How has domestic violence in Westchester County been impacted by the COVID-19 pandemic and what resources are available to those in need? That’s the subject of a video created by the Safe Coalition: Children, Families, Community. The video examines the effect of the outbreak on domestic violence and provides information on the many robust and collaborative resources available to families. Lauren Pomerantz, LCSW, Coordinator of the Safe Coalition, is joined by local domestic violence experts in Westchester County. The conversation is moderated by Laura Daniels, Esq, Westchester County Family Law Attorney, and includes:
-Susan Carroll, Esq, Director of Training, Outreach and Education at the Pace Women’s Justice Center
-Michelle James-Walker, Director of the Westchester County Family Justice Center
-Koffman, Prevention Program Coordinator and Counselor at Hope’s Door
-Darlene Reda, Esq, Program Administrator at Westchester County Office for Women
Please consider sharing this video with your friends, family and any other organization with whom you are affiliated.
