Updated July 26, 2024
St. Peter's Health Partners leaves UnitedHealthcare's network
Despite months of hard work and repeated efforts to reach a compromise, we were unable to reach an agreement with St. Peter’s Health Partners (St. Peter’s) in upstate New York. However, in compliance with state cooling off requirements, the first day out of network differs by the provider type and the benefit plan people are enrolled in. Please see the following:
St. Peter’s physicians are now out of network for the following benefit plans, as of July 1, 2024:
- Employer-sponsored and individual commercial plans, including both ASO (self-funded) and fully insured, as well as Oxford Health Plans
- Medicare Advantage plans, including Group Retiree as well as our Dual Special Needs Plan (DSNP)
St. Peter’s hospitals and facilities are now out of network for the following benefit plans, as of July 1, 2024:
- Medicare Advantage plans, including Group Retiree as well as DSNP
- ASO commercial plans
Important note for people enrolled in our Medicaid plans: in compliance with state cooling off requirements, St. Peter’s hospitals, facilities and physicians remain in our network through Aug. 31, 2024.
Important note for people enrolled in a fully insured commercial plan: People enrolled in a UnitedHealthcare fully insured commercial plan have continued network access to only St. Peter’s hospitals, through Aug. 31, 2024, in accordance with New York cooling off requirements. Please note cooling off does not apply to St. Peter’s ancillary provider locations. Those facilities are out of network for fully insured commercial members, as of July 1.
Our goal was to reach an agreement that was affordable and ensured continued, uninterrupted access to St. Peter’s for the New Yorkers we serve. Unfortunately, St. Peter’s, which is owned by Michigan-based Trinity Health, rejected our proposal to extend our current contract, which would have ensured continued network access to the health system while we continued our discussions.
We made multiple compromises throughout our negotiation, including proposing meaningful rate increases that would have ensured St. Peter’s providers continued to be reimbursed at market-competitive rates. Unfortunately, St. Peter’s has maintained its demands for price hikes that aren’t affordable or sustainable for the people and employers we serve.
While we remain open to discussions with St. Peter’s, our primary focus at this time is ensuring New York families have uninterrupted access to the care they need through either continuity of care or supporting them as they transition to new care providers. We know that network changes can be difficult, but our members can rest assured that they will continue to have access to high-quality, affordable care from a broad network of hospitals and physicians.
UnitedHealthcare members who need assistance finding a new provider or have questions about continuity of care can call us at the number on their health plan ID card. We have also created FAQs below to provide additional information regarding alternate providers remaining in our network in the area as well as details regarding continuity of care.
St. Peter’s demands for an unaffordable price hike would make health care more expensive for families and employers in upstate New York
At a time when many Americans and their employers are struggling financially, St. Peter’s continues to demand unreasonable price hikes that are neither affordable nor sustainable for families and employers in the Albany region.
Excessive rate increases drive up overall health care costs, directly resulting in a financial strain for the members we serve, including impacting the benefits we are able to provide to seniors who are enrolled in our Medicare Advantage plans.
Agreeing to St. Peter’s proposed rate increases will drive up premiums and out-of-pocket costs for our members, as well as the cost of doing business for our employer-group customers, impacting their ability to offer health care coverage for their employees.
We recognize that St. Peter’s is an important care provider and have offered meaningful, market-competitive rate increases that will ensure St. Peter’s hospitals and physicians continue to be fairly compensated for the important care they provide to our members.
We remain open to conversation with St. Peter’s but take seriously the impact that rate increases have on our customers, members and overall health care costs. We are asking St. Peter’s to work with us to reach an agreement that families and employers in the Albany region can afford.
Employers could face large cost increases if we agreed to St. Peter’s demands
More than 70% of our employer-sponsored members in New York are enrolled in self-funded plans, which means that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims.
A majority of the price hike St. Peter’s is seeking would come out of the operating budgets of our self-funded employers.
Our employer group customers have charged us with the responsibility of providing their employees access to quality, affordable health care. We pass any savings from negotiating more competitive rates directly to our self-funded customers, which they could in turn use to hold premiums steady for employees or to lower them in some cases. Employers can also use any savings to enhance benefits, increase salaries or help grow their organization.
As the prices for health care continue to rise, employers have less money available to help grow the business through things like investments in new technologies or salary increases for hard-working employees.
As many businesses struggle to attract and retain the employees they need, we are hopeful St. Peter’s will work with us to reach an agreement at fair, market- competitive rates that will ensure the people and customers we serve can continue to afford care at St. Peter’s hospitals and with its physicians.
St. Peter’s is putting New York’s most vulnerable residents in the middle of this negotiation in an effort to secure rate increases, potentially creating unnecessary and completely avoidable disruption in access to care for our Medicaid members.
We already have an agreement on rates for our Medicaid plans and provided a proposal to finalize the terms through a separate contract for government plans. This would have ensured uninterrupted access to St. Peter’s hospitals and physicians for our UnitedHealthcare Community Plan of New York members while we continued to work to renew our commercial relationship.
We also requested an extension to our current contract to give both organizations additional time to reach an agreement without creating stress and anxiety for our members.
Unfortunately, St. Peter’s refused both of our offers, presumably to pressure us to give into its demands for an unreasonable increase in the rates for people enrolled in our employer-sponsored health plans.
We are disappointed that St. Peter’s is putting New York’s most vulnerable residents in the middle of this negotiation and that Medicaid members could potentially lose in-network access to care because of St. Peter’s unwillingness to negotiate fair and responsible contracts
We remain committed to reaching an agreement that helps ensure the families and employers we serve have access to quality care at an affordable cost
We know the relationship our members have with their doctor is not only important; it’s personal. That is why it remains our top priority to reach an agreement with St. Peter's so the New Yorkers we serve have continued access to the facilities and physicians 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 urge St. Peter's to do what's in the best interests of the communities we collectively serve and to reach an agreement that's affordable and sustainable for New York families and employers.
We have created the following FAQs to ensure you and your family have the information needed regarding next steps as well as details to help meet your health care needs
FAQs
Despite months of hard work and repeated efforts to reach a compromise, we were unable to reach an agreement with St. Peter’s Health Partners (St. Peter’s) in upstate New York. As a result, St. Peter’s Health Partners Medical Associates’ providers and St. Peter’s hospitals are out of network for members enrolled in employer-sponsored and individual commercial plans, Medicare Advantage and Group Retiree plans, Dual Special Needs Plans (DSNP), as well as UnitedHealthcare Community Plans in New York (Medicaid), effective July 1, 2024:
In compliance with New York cooling off requirements, members enrolled in fully insured commercial plans will have continued network access to all of St. Peter’s hospitals through Aug. 31, 2024. Members enrolled in Medicaid managed care plans will have continued network access to St. Peter’s hospitals and physicians through Aug. 31, 2024.
This is of course not the outcome we have been hoping for, and we remain committed to continuing to work with St. Peter’s to renew our relationship. We requested an extension to our current contract to give both organizations additional time to reach an agreement without creating stress and anxiety for our members. We are disappointed that St. Peter’s rejected this request.
We have made multiple compromises throughout our negotiation, including offering market-competitive rate increases that will ensure St. Peter’s hospitals and physicians continue to be fairly compensated for the care they provide to our members. We are disappointed that St. Peter’s has continuously rejected these offers and is unwilling to acknowledge that its unreasonable rate request would significantly drive-up health care costs for the people we serve in the Albany region.
While we remain open to discussions with St. Peter’s, our primary focus at this time is ensuring that the members we serve have uninterrupted access to the care they need through either continuity of care or supporting them as they transition to new care providers. We know that network changes can be difficult, but our members can rest assured that they will continue to have access to high-quality, affordable care from a broad network of hospitals and physicians.
St. Peter’s providers and hospitals are now out of network for members enrolled in employer-sponsored and individual commercial plans, Medicare Advantage and Group Retiree plans, Dual Special Needs Plans (DSNP), as well as UnitedHealthcare Community Plans in New York (Medicaid), effective July 1, 2024.
In compliance with New York cooling off requirements, members enrolled in fully insured commercial plans will have continued network access to all of St. Peter’s hospitals through Aug. 31, 2024. Members enrolled in Medicaid managed care plans will have continued network access to St. Peter’s hospitals and physicians through Aug. 31, 2024.
The following hospitals will be out of network on July 1, 2024:
- St. Peter’s Hospital
- Samaritan Hospital
- Samaritan Hospital - Albany Memorial Campus
- Sunnyview Hospital and Rehabilitation Center
St. Peter’s Health Partners Medical Associates’ providers and hospitals are out of network for members enrolled in employer-sponsored and individual commercial plans, Medicare Advantage and Group Retiree plans, Dual Special Needs Plans (DSNP), as well as UnitedHealthcare Community Plans in New York (Medicaid), effective July 1, 2024.
In compliance with New York cooling off requirements, members enrolled in fully insured commercial plans will have continued network access to all of St. Peter’s hospitals through Aug. 31, 2024.
Members enrolled in Medicaid managed care plans will have continued network access to St. Peter’s hospitals and physicians through Aug. 31, 2024.
We know that network changes can be difficult, but our members can rest assured that they will continue to have access to high-quality, affordable care from a broad network of providers and hospitals across the Albany region, including:
- Ellis Hospital
- Saratoga Hospital
- Columbia Memorial Hospital
- Albany Medical Center Hospital (for members enrolled in commercial and Medicare HMO plans)
Members enrolled in our Medicare Advantage PPO plans may receive care from an out-of-network provider, if the provider is a Medicare participating provider which accepts the plan. If members have a Group Retiree PPO plan, the member’s share of the cost is typically the same as if the provider was part of the network.
- UnitedHealthcare Group Retiree members are encouraged to speak with the provider to confirm they will provide care, regardless of their network status.
For support finding in-network physicians and hospitals, members can call the customer care number on their health plan ID card or visit their plan’s website:
- myuhc.com
- myuhcmedicare.com
- retiree.uhc.com for Group Retiree plans
- uhc.com/communityplan/new-york
Impacted members will be matched with a new in-network physician and medical group in their area. If a member is satisfied with their new physician and medical group, they don’t need to do anything and a new member identification card with updated medical group and physician information will be mailed to them.
If a member prefers to select their own physician, they can choose a new medical group and PCP from our network at any time.
Members enrolled in our Medicare Advantage PPO plans may receive care from an out-of-network provider, if the provider is a Medicare participating provider which accepts the plan. If members have a Group Retiree PPO plan, the member’s share of the cost is typically the same as if the provider was part of the network.
- UnitedHealthcare Group Retiree members are encouraged to speak with the provider to confirm they will provide care, regardless of their network status.
For support finding in-network physicians and hospitals, members can call the customer care number on their health plan ID card or visit their plan’s website
- myuhc.com
- myuhcmedicare.com
- retiree.uhc.com for Group Retiree plans
- uhc.com/communityplan/new-york
If we reach an agreement with St. Peter’s in the future and a member has already been matched with or selected a new PCP, members can call the phone number on the back of their health plan ID card to reselect a St. Peter’s physician or St. Peter’s medical group at that time.
UnitedHealthcare members who are in the middle of treatment at a St. Peter’s hospital or from a St. Peter’s physician 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. Examples of patients who may qualify include:
- Women who are pregnant (at any time during a pregnancy) and post-partum directly related to the delivery.
- Patients with newly diagnosed or relapsed cancer, or those currently in active cancer treatment.
Members who have questions about continuity of care should call the number on their health plan ID card.
In the event of an emergency, UnitedHealthcare members should go to the nearest hospital. Emergency care will be covered at the in-network benefit level, regardless of whether the hospital participates in our network.
Members enrolled in our Medicare Advantage and Group Retiree plans may continue to receive care at a St. Peter’s facility and from a St. Peter’s physician, if the provider is Medicare-approved and accepts the plan.
The member’s share of the cost is typically the same as if the provider was part of the network.
Members enrolled in our Medicare Advantage and Group Retiree plans are encouraged to speak with the provider to confirm they will provide care, regardless of their network status.
In the event of an emergency, UnitedHealthcare members should go to the nearest hospital. Emergency care will be covered at the in-network benefit level, regardless of whether the hospital participates in our network.
We remain committed to working with St. Peter’s and requested an extension to our current contract to give both organizations additional time to reach an agreement without creating stress and anxiety for our members.
We are disappointed that St. Peter’s rejected this request.
We will remain at the negotiating table with St. Peter’s for as long as it takes to reach an agreement that will ensure the people we serve have continued access to care that is both quality and affordable.
We urge St. Peter’s to work with us to reach an agreement so that our members have continued access to St. Peter’s hospitals and providers.
UnitedHealthcare members should always go to the nearest hospital in the event of an emergency. Their services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.
For support finding in-network physicians, members can call the customer care number on their health plan ID card or visit their plan’s website:
- myuhc.com
- myuhcmedicare.com
- retiree.uhc.com for Group Retiree plans
- uhc.com/communityplan/new-york