New York City’s most expensive health system is demanding a price hike of nearly 30%

Montefiore is a clear outlier in New York City as well as the entire state in terms of what it expects to be paid for the care its hospitals and physicians provide. Not only is Montefiore the most expensive health system in New York City, but the rates we reimburse its hospitals at its Moses and Einstein campuses are also higher than any other hospital in the entire state.

The hospitals on these campuses are also markedly more expensive than some of the most reputable and prestigious hospitals in the entire country, with rates that are 38% higher than the average cost at the top five hospitals in U.S. News & World Report’s 2020-21 rankings of the best hospitals in the United States. All five of those hospitals are highly prestigious and nationally known as the best in the country, making them “destination hospitals” for people across the country seeking top-quality health care. Health care costs would be reduced by $32 million per year if Montefiore accepted the average rate we pay these five hospitals for care provided on its Moses and Einstein campuses.

Despite these high costs, Montefiore is demanding a nearly 30% price hike over the next three years, which would drive up health care costs by $216 million

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 for our members, as well as increase the cost of doing business for both self-insured and fully insured companies.

If we agreed to these demands, the average cost of care at Montefiore’s hospitals for people enrolled in our employer-sponsored and individual plans would be nearly five times what Medicare would pay the hospital for the same services. In other words, if Montefiore charged $100 for a service provided to a senior on Medicare, it would charge nearly $500 for the exact same service when provided to a UnitedHealthcare member enrolled in an employer-sponsored plan.

Montefiore’s high rates are challenging New York City employers’ ability to offer affordable health care benefits

Health care costs continue to be a top concern for consumers and employers, and they expect us to make health care more affordable. That’s especially true today, as millions of Americans and employers are struggling financially due to COVID-19. That is why we’re working to balance Montefiore’s rate demands with the economic needs of the employer group customers we serve in New York City. We hope Montefiore will work with us to ensure the people and customers we serve can continue to afford care at Montefiore.

For years, Montefiore has price-gouged employer-group customers to make up for the lower rates it receives for care provided to Medicare and Medicaid patients. This pattern can no longer continue.

As the largest provider of small business health plans in downstate New York, we have a responsibility to ensure the more than 50,000 small businesses we serve in the area can continue to provide their 480,000 employees with affordable health care benefits. As businesses throughout New York City, the Bronx and Westchester County struggle to keep their doors open and face tough decisions about layoffs and pay cuts, it’s more critical now than ever that we ensure they have access to affordable health care. Agreeing to Montefiore’s demands for a nearly 30% price hike would impact many of these businesses’ ability to offer health care coverage for their employees.

These demands would also directly drive up health care costs for our self-insured customers, given that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims. In New York City and the surrounding communities, more than 50% of our commercial members are enrolled in self-insured plans. Agreeing to a nearly 30% price hike would mean 15 of our self-insured group customers would see their health care costs go up by more than $1 million, while our largest customers would incur a $5 to $10 million increase over the next three years for their company's health care costs.

We’ve compromised and offered rate increases while Montefiore has dug in its heels and demanded an egregious price hike

Our top priority is to renew our relationship and ensure our members have continued access to Montefiore’s hospitals and physicians. Throughout our negotiation we’ve worked to find a middle ground that balances Montefiore’s rate demands with the economic needs of the employer group customers and members we serve.

We recognize that hospitals and doctors throughout New York have been some of the hardest hit by the COVID-19 pandemic. That is why we have never asked Montefiore to accept rate decreases and are now offering to raise the rates we pay most of Montefiore’s hospitals, despite its position as the most expensive health system in New York City. This latest proposal demonstrates our willingness to compromise as part of good-faith negotiations designed to get a deal done. Montefiore, on the other hand, has refused to engage in meaningful negotiations and continues to demand price hikes of nearly 30%.

We hope Montefiore, which has received more than $1 billion in federal aid during the pandemic – with more than $600 million in CARES Act relief and more than $400 million in additional federal aid – will work with us to help make health care more affordable for New Yorkers who have been hit hard financially by the COVID pandemic.

Montefiore is using its most vulnerable patients to pressure us to accept its price hike demands – potentially risking the health care of thousands of people

While we agree on rates for our Medicaid plans, Montefiore will not finalize the contract unless we accept their nearly 30 percent price hike demands on our commercial members. This puts the health of nearly 30,000 New Yorkers at risk who are served by the UnitedHealthcare Community Plan of New York and use Montefiore doctors and facilities.

Our Members’ Continued Access to Care if Montefiore Leaves Our Network

We understand how disruptive it can be for our members and their families when a hospital or physician no longer participates in our network. We are fortunate to have a broad network of hospitals and physicians in the Bronx, New York City, Westchester County and the surrounding metropolitan areas that are readily able to provide high-quality care that meets the needs of our members.

Our members can choose from 13,000 adult primary care physicians (PCPs), 6,300 pediatric PCPs and 49,000 specialists in downstate New York, as well as some of the top hospitals in the country, including:

  • Mount Sinai Health System
  • New York Presbyterian
  • NYC Health + Hospitals
  • Westchester Medical Center

UnitedHealthcare members who are in the middle of treatment at a Montefiore facility or with one of its physicians may qualify for continuity of care, which provides continued in-network benefits for a specified period of time after a hospital or physician leaves our network. A few examples of patients who may qualify include:

  • Women who are pregnant
  • Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment
  • Transplant recipients in need of ongoing care due to complications associated with a transplant

Members who have questions about continuity of care or alternative hospitals in their area should call the number on the back of their health plan ID card.

Members can also use the provider directory on our member websites to search for alternative hospitals and doctors:

On behalf of the nearly 4 million UnitedHealthcare members throughout New York, we remain committed to reaching a long-term solution with Montefiore that ensures the people and employer group customers we’re honored to serve have access to quality, more affordable care.