After a nearly year-long stalemate that left tens of thousands of New York City patients scrambling to access coverage, the two parties say they’ve reached an agreement that will restore Montefiore’s services to those with employer-sponsored UHC and Oxford plans come Dec. 1.
After a nearly year-long stalemate that left tens of thousands of New York City patients scrambling to access medical coverage, major insurer United Healthcare and provider Montefiore Health System have finally reached an agreement.
The new terms go into effect Dec. 1, and will restore access of Montefiore’s services to employer-sponsored plans with UnitedHealthcare and Oxford and patients covered under Medicare Advantage Dual Special Needs, according to the insurer.
The 10 hospitals, including a major hospital in the Bronx, and more than 200 medical facilities owned by Montefiore will be considered in-network as of that date.
The two companies parted ways last winter after a dispute over cost of reimbursements for care, leaving patients in the lurch as they found their regular providers to be suddenly out-of-network.
“The long-term health of our patients has always been the central focus of our negotiations,” said Colleen Blye, executive vice president, chief financial officer of Montefiore Health System, in Thursday’s statement announcing the resolution.
In May, affected patients experienced a moment of hope when United Healthcare distributed a letter to employers claiming that they had offered Montefiore a hefty increase in rates — more than double the original offer, an executive told City Limits this summer.
“While the rate increases we have proposed are significantly more than the market demands and exceed the most recent monthly Consumer Price Index for All Medical Care, we delivered this proposal in the spirit of compromise and to end the disruption the community has experienced,” the letter said.
But details of the offers on the table then remained elusive. Montefiore executives say the offer was actually less than what was presented and nixed the deal.
“Due to COVID, Montefiore is losing $40 million per month so far in 2021,” the hospital wrote in a June 4 response to the insurer. “United is on track in 2021 to make record-breaking profits of more than $26 billion, yet still they are requesting 16 percent premium hikes to small business owners in New York in 2022, which follows a trend of United asking for double digit increases amounting to more than 65 percent over the past 4 years.”
Both parties said the other was misrepresenting the figures, but neither company would share the proposed contracts with City Limits.
Meanwhile, the insured individuals affected, including employees of multiple Bronx nonprofits, had to find new doctors. Zuleyca Villa, who City Limits interviewed this summer, was forced to find an in-network hospital only two weeks before a scheduled C-section. City Limits also interviewed a cancer patient, who wished to remain unnamed, who was distressed to switch to a new primary-care physician in the wake of the dispute.
“We recognize and appreciate the care Montefiore provides is important and personal to our members, and we also know the negotiation process has been difficult for them,” said Michael McGuire, CEO of UnitedHealthcare New York.
Liz Donovan is a Report for America corps member.