Frequently asked questions (FAQs)
The timing of when our members will lose in-network access will depend on the type of plan they’re enrolled in:
- Employer-sponsored self-insured (ASO): Montefiore physicians and hospitals out of network, effective Jan. 1, 2021
- Employer-sponsored and individual fully insured plans, including Oxford: Montefiore physicians out of network, effective Jan. 1, 2021; Montefiore hospitals out of network, effective March 1, 2021
- Community Plan (Medicaid): Montefiore physicians out of network, effective Jan. 1, 2021; Montefiore hospitals out of network, effective March 1, 2021
- Medicare Advantage DSNP: Montefiore’s hospitals and physicians out of network, effective April 1, 2021
- Medicare Advantage ISNP: Montefiore physicians out of network, effective April 1, 2021
Montefiore does not participate in our network for people enrolled in standard Medicare Advantage plans, with the exception of Montefiore St. Luke’s Cornwall Hospital. Our contract with St. Luke’s for our Medicare Advantage plans is not impacted by this negotiation.
Maintaining stability in our network of doctors and hospitals is extremely important to us. At the same time, 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 New Yorkers and businesses face financial challenges stemming from the COVID-19 pandemic.
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. Montefiore is the most expensive health system in New York City, and the cost of care at its Moses and Einstein campus hospitals is higher than at any other hospital in our network in the entire state. These hospitals 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.
Despite its egregiously high costs, Montefiore maintained its demand for a nearly 30% price hike for its hospitals and physicians over the next three years for our employer-sponsored and individual plans. Agreeing to Montefiore’s proposal would have increased health care costs by more than $200 million for New York businesses and families. Montefiore’s demand to increase its already egregiously high rates was unreasonable at a time when so many people 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.
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 demonstrated our willingness to compromise as part of good-faith negotiations designed to get a deal done. Montefiore, on the other hand, refused to engage in meaningful negotiations and continued to demand price hikes of nearly 30% over the next three years.
No. We recognize these are extraordinarily challenging times for New Yorkers as well as our entire country as we battle the COVID-19 pandemic. When it became clear that our ongoing discussions with Montefiore were not likely to lead to an agreement, we offered to allow our members to have network access to Montefiore’s hospitals and physicians through May 31, 2021, while we continue our efforts to renew our relationship. Unfortunately, Montefiore refused, unnecessarily disrupting access to its hospitals and physicians for thousands of New Yorkers.
Putting our members in the middle of our negotiation and unnecessarily disrupting network access for its patients is nothing new for Montefiore. For the past few months, we have had an agreement on rates for our Medicaid plan. Despite repeated requests to Montefiore that we finalize the contract so some of New York’s most vulnerable patients could continue accessing care at the health system’s hospitals and physicians, Montefiore refused. This has put nearly 30,000 New Yorkers enrolled in the UnitedHealthcare Community Plan of New York in the middle of our negotiation, presumably because Montefiore hoped the potential disruption in care for our Medicaid members would pressure us to give into its nearly 30% price hike demands on our commercial members.
Our top priority was to renew our relationship and ensure our members continued access to Montefiore’s hospitals and physicians, but we also wanted the care to be affordable, both for our members and for our employer customers. Throughout our negotiation we worked to find a middle ground that balanced Montefiore’s rate demands with the economic needs of the employer group customers and members we serve.
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 the greater New York metropolitan area 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 could impact 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, more than 50% of our commercial members are enrolled in self-insured plans. Agreeing to Montefiore’s demands 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 in their health care costs over the next three years.
We are asking Montefiore to work with us to restore access to its hospitals and physicians and slow the unsustainable rise in health care costs so that the people we serve in New York have access to quality, more affordable care.
No. 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 all of Montefiore’s hospitals, despite its position as the most expensive health system in New York City These proposals demonstrated our willingness to compromise as part of good-faith negotiations designed to get a deal done. Montefiore, on the other hand, refused to engage in meaningful negotiations and continued to demand price hikes of nearly 30% over the next three years.
Unfortunately, while we agree on rates for our Medicaid plan, Montefiore refused to finalize the contract unless we accepted its nearly 30% price hike demands on our commercial members. This unnecessarily put nearly 30,000 New Yorkers who are enrolled in the UnitedHealthcare Community Plan in the middle of our negotiation, presumably because Montefiore hoped the potential disruption in care for our Medicaid members would pressure us to give in to its price hike demands.
Montefiore has not participated in our Medicare Advantage network since 2018. However, our UnitedHealthcare Group Medicare Advantage National PPO plan, which is offered to beneficiaries who get their Medicare coverage through their former employer, gives our members the flexibility to receive care from providers that don’t participate in our network for no additional out-of-pocket cost beyond what they would pay to see a network provider, as long as the care provider agrees to care for them. When out-of-network doctors and hospitals provide care to our members enrolled in our Group Medicare Advantage National PPO plan, we reimburse them at the same rate they receive for treating patients enrolled in Original Medicare.
Our top priority is ensuring our members have access to the care they need. UnitedHealthcare members in active treatment at a Montefiore facility or with a Montefiore physician, or those who have a significant acute or chronic condition, may be able to continue receiving covered services for a limited time even after the contract expires. This is called continuity of care. 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
Some employer group plans offer unique, expanded continuity of care benefits. UnitedHealthcare members should call the number on the back of their health plan ID card if they have questions about their plan’s continuity of care benefits or to see if they may qualify.
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 and New York City metro area that are readily able to provide high-quality care that meets the needs of our members.
Our members can choose from more than 13,000 adult primary care physicians, 6,300 pediatric primary care physicians and nearly 49,000 specialists in the area, as well as nearly 100 hospitals in downstate New York, including some of the top hospitals in the country. Some examples of hospitals remaining in our network include:
- Mount Sinai Health System
- New York Presbyterian
- NYC Health + Hospitals
- Westchester Medical Center
- Bon Secours Community Hospital
- BronxCare Hospital Center
- Garnet Health Medical Center
- St. Barnabas Hospital
- St. John’s Riverside Hospital
- St. Anthony Community Hospital
UnitedHealthcare members who need help locating a network hospital or physician can call the number on their health plan ID card. Our customer care advocates are ready to serve them. Members can also review our provider directory on their member website: myuhc.com® for our commercial members, myAARPMedicare.com for our Medicare Advantage DSNP and ISNP members, and uhccommunityplan.com/for-members for our Community Plan members.
UnitedHealthcare members should always go to the nearest hospital in the event of an emergency. Their care will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.