Negotiations Between United Healthcare and Montefiore Health System Break Down

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."