New Yorkers insured through UnitedHealthcare and Oxford Health Plans could soon lose most in-network coverage at Mount Sinai Health System, unless Mount Sinai and United resolve a dispute over the cost of medical services before the new year.
Emergency care at Mount Sinai hospitals would remain covered at in-network rates, but pre-planned visits would not. That means United members — including those covered through Oxford, which United owns — could have to pay out of pocket if they want to schedule procedures at Mount Sinai Morningside, Mount Sinai Brooklyn or the New York Eye and Ear Infirmary, among other facilities.
Mount Sinai’s network of doctors would remain in-network with United, according to Mount Sinai. But the change could make it difficult for those doctors to refer patients to Mount Sinai hospitals for follow-up care.
The current contract between Mount Sinai and United is set to expire at the end of 2023. If negotiations break down, some members will not feel the effects until March, because of a state-mandated “cooling off” period, according to United. MedicareAdvantage plans would not be affected by the change.
United Healthcare has posted on its website that Mount Sinai is proposing “outlandish” price hikes for medical services that could drive up insurance costs for both patients and employers. Mount Sinai has countered that United currently pays about 30% less for its services than it pays comparable hospital networks in the area.
“We urge the health system to approach the negotiating table with a realistic proposal New Yorkers and employers can afford,” United spokesperson Cole Manbeck said in a statement.
A Mount Sinai spokesperson said Tuesday that there is still hope that a last-minute deal can be reached.
“For several months, Mount Sinai has been working in good faith with United Healthcare, which also owns Oxford Health Plans, to establish a new, fair agreement that will put patients first and protect patients’ ability to…
Read the full article here
Leave a Reply