Updated February 14, 2024

Mount Sinai is now out of network due to its demands for a near 50% price hike that would increase health care costs by more than $600 million over the next three years

Our existing contract with Mount Sinai was a three-year agreement that took effect on Jan. 1, 2022 and provided the health system with annual, market-competitive rate increases. Less than 20 months into the new agreement, Mount Sinai issued a notice to end our current contract for its hospitals and demanded price hikes significantly higher than the rates we previously agreed to.

Due to Mount Sinai’s refusal to move off its demands for a near 50% price hike over the next three years, the health system’s hospitals are now out of network for our employer-sponsored and individual plans, including the Oxford Health Plan, as of Jan. 1, 2024.

Our goal was to keep Mount Sinai’s hospitals in our commercial network at rates that are affordable for New Yorkers and employers. That’s why we have repeatedly compromised and proposed meaningful rate increases that would have ensured Mount Sinai continued to be fairly and appropriately reimbursed.

Unfortunately, Mount Sinai continues to propose outlandish price hikes that are more than five times higher than the Consumer Price Index for hospital services over the past 12 months.

Mount Sinai’s proposal would increase health care costs by more than $600 million over the next three years, which is not realistic and would significantly drive up premiums and out-of-pocket costs for consumers as well as the cost of doing business for employers. For example, we estimate Mount Sinai’s proposal for a near 50% price hike would directly increase our members’ cost share – or the amount they pay out-of-pocket for care – by approximately $100 million.

This negotiation initially only impacted Mount Sinai’s hospitals. However, our credentialing plan requires that the physicians who participate in our network have the ability to admit patients to at least one in-network hospital. In December, we provided advance notice to Mount Sinai physicians that they would need to obtain admitting privileges to at least one in-network hospital over the next few months, should Mount Sinai’s hospitals leave our network. Unless they obtain admitting privileges to another in-network hospital, the majority of Mount Sinai’s physicians will no longer participate in our network for employer-sponsored and individual plans, including the Oxford Health Plan, effective March 22, 2024.

Important facts and what this means for you

  • This negotiation only impacts our contract with Mount Sinai for employer-sponsored and individual commercial plans, including the Oxford Health Plan.
  • People enrolled in UnitedHealthcare fully insured commercial plans have continued network access to all of Mount Sinai’s hospitals through Feb. 29, 2024, due to New York cooling off requirements.
  • People enrolled in non-Oxford ASO (self-insured) commercial plans will continue to have network access to only Mount Sinai Hospital and Mount Sinai Hospital of Queens through Feb. 29, 2024.
  • People enrolled in level-funded plans are not eligible for cooling off and all Mt Sinai facilities are out of network beginning 1/1/24.
  • Unless they obtain admitting privileges to another in-network hospital, the majority of Mount Sinai’s physicians will no longer participate in our network for employer-sponsored and individual plans, including the Oxford Health Plan, effective March 22, 2024.
  • This negotiation only impacts our relationship with Mount Sinai for employer-sponsored and individual commercial plans, including Oxford. All other active contracts, including Medicare Advantage and the Empire Plan, remain in place with no change.

Mount Sinai’s proposal would make its hospitals the most expensive by a considerable margin in New York City, where three other hospitals rank in the top 22 of U.S. News and World Report’s rankings for best hospitals in the United States.1

Mount Sinai’s proposal would make its hospitals an outlier in the market and significantly more costly than its peers, many of which are nationally renowned for providing high-quality care.

Mount Sinai is demanding a 70% overall price hike at Mount Sinai Hospital, the health system’s flagship facility, including a 95% increase in costs specific to outpatient services received at the hospital.

Mount Sinai has placed the largest rate increases on its main campus facility where a higher percentage of our members go for care, leading to an even greater increase in health care costs for New Yorkers and employers.

Nearly $300 million of Mount Sinai’s proposed price hikes would come out of the operating budgets of self-insured employers

Mount Sinai’s demands for a near 50% rate increase would directly drive up health care costs for our self-insured employers. More than 15 self-funded businesses would see their health care costs go up by more than $2 million each, while some of the most heavily impacted employers would see their costs increase between $4 million to as much as nearly $13 million.

Approximately 50% of our commercial members in New York City are enrolled in self-funded plans, meaning their employers assume the risk and pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to take on that risk and pay those claims.

Mount Sinai’s proposal would also have a significant impact on thousands of small businesses throughout New York City. Roughly 98 percent of the employers in New York City are small businesses that provide jobs to more than 3 million people, which is about half of the city’s work force.

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 employees with affordable health care benefits. This also helps ensure they have money available to help grow their business through investments in new technologies or increase salaries for their employees. That is why we’re focused on reaching an agreement with Mount Sinai at rates that are affordable for New Yorkers and employers.

Mount Sinai’s physician contract is not up for negotiation. However, the health system is attempting to leverage them as part of our negotiation and is demanding a near $160 million price hike for its physicians as part of the more than $600 million overall increase the health system is seeking. Mount Sinai’s proposal would make its physicians significantly higher cost than any other physician group in our network throughout New York City.

We remain committed to continued good-faith negotiation with the goal of restoring network access to Mount Sinai. We hope the health system will join us at the negotiating table with a reasonable proposal that’s affordable and sustainable for New Yorkers and employers throughout New York City.

We know the relationship people have with their health care providers is not only important; it’s personal. That is why our top priority is to reach an agreement with Mount Sinai so the people we serve have restored network access to the hospitals they know and trust for their health care needs. We are committed to meeting with the health system as often as it takes to reach a new agreement.

We have created the following page dedicated to information about continuity of care as well as alternative physicians and hospitals remaining in our network.

Important information for our members