Still No Deal Between UnitedHealthcare and Major Bronx Hospital

The impasse between UnitedHealthcare and Montefiore Health System continues, as both sides refused to agree to new terms.

Last week, Catherine Clarke of the University Neighborhood Housing Program in the Bronx received an email that she said offered a “glimmer of hope.”

She and her colleagues, who provide affordable housing and financial-planning services for residents of the Bronx, had been cut off from their neighborhood hospital at the start of the year when their health insurance provider, UnitedHealthcare, announced it would no longer include Montefiore Health System as part of its network. The separation followed a disagreement over reimbursement rates between the insurer and the health network, which includes a major Bronx hospital, multiple medical centers in Westchester County and a nursing school. It affected the insurance of about 60,000 patients and their employers.

Nearly six months later and following coverage of the dispute by City Limits, UnitedHealthcare sent a letter to affected employers earlier this month saying that the company was attempting to compromise.

The insurer claimed in the letter, reviewed by City Limits, that on May 28, it had offered Montefiore an increase of reimbursement rates to the tune of $184 million over the next five years.

“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. (Read the full text of UnitedHealthcare’s letter.)

But hopes for an agreement were quickly dashed.

Late last week, Montefiore sent a response to employers nixing the proposal and disputing what United claims it put forward. (The response was also posted on the website KeepMontefiore.org, which has been providing updates about the dispute.)

“All United offered was $5M additional in upfront cash yet they continue to owe us more than $95 million for care already provided — and that number continues to grow,” Montefiore’s rebuttal said.

Montefiore says it made another proposal on June 4 asking for increases in reimbursement rates to help cover losses in revenue due to the pandemic.

“The truth is in the numbers: Due to COVID, Montefiore is losing $40 million per month so far in 2021,” the response read. “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.”

In a separate dispute, UnitedHealthcare has faced national backlash recently for a proposal to cut reimbursement rates for what it considers “nonurgent” emergency room visits. The insurer ultimately postponed that policy change after outcry from those who criticized the timing of doing so during the ongoing COVID-19 crisis.

Montefiore claims that their proposal is comparable to what other insurers are paying and that the increases they are asking for are less than the increases from their previous contract with UnitedHealthcare in 2018, before the pandemic, according to a spokesperson. It also claims that United is basing its rates on 2019 intake numbers, which do not accurately reflect the number of patients the health system has admitted since the pandemic began last March. The hospital network says it experienced a 24 percent decline in patient admissions from 2019 to 2020.

A spokesperson for UnitedHealthcare said that Montefiore’s  latest proposal was not sustainable or affordable.

“We delivered a new five-year proposal to Montefiore on May 28 that more than doubled our previous offer and would provide the health system with a $184 million increase over the next five years compared to Montefiore’s 2020 reimbursement rates, which were already the highest of any health system in New York City,” the spokesperson said in a statement to City Limits.

The spokesperson said that the company was instead demanding annual rate increases of more than 7 percent over the next five years, which would increase health care costs by $433 million over the length of the deal.

“Agreeing to those demands 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,” the spokesperson said, adding that Montefiore’s most recent proposal included only one change: a 0.25% reduction the fourth year, or a $2 million decrease overall.

As of now, the stalemate continues. Both companies claim that the other is misrepresenting its numbers but neither was willing to share the actual proposals that had been submitted.

Patients caught in dispute

The back-and-forth between the two companies has policyholders feeling frustrated and uncertain about how to proceed with their ongoing medical issues in the midst of a global health crisis.

“We’re sort of on a rollercoaster,” said Jumelia Abrahamson, who also works for University Neighborhood Housing Program and who suffers from chronic migraines. “On Friday we felt optimistic that there was a possibility that our relationships with our doctors were going to be back on the table. But now … we may need to find a new provider and re-establish our relationships. So it’s a lot of mixed emotions.”

Zuleyca Villa, 33, was two weeks away from a scheduled C-section at Montefiore St. Luke’s Cornwall Hospital, in Newburgh, N.Y., when she received a phone call from the hospital saying that the facility was no longer in her insurance network. She spent two days scrambling to find another hospital that was able to perform the procedure on a different day. She then had to change the arrangements she had made for care for her 5-year-old son while she was admitted.

“It was so chaotic, and it was so stressful,” she told City Limits. “I’m going to give birth with a doctor that I don’t have a connection with, who I’ve only seen twice, in a hospital I’ve never been to.”

When City Limits originally reported on the dispute last month, Assemblyman Jeffrey Dinowitz, who represents the area of the Bronx where Montefiore is headquartered, expressed frustration that the state has not intervened.

“I think they could bring pressure,” he told City Limits in May. “I don’t have the impression that has happened. If they got a call from the Commissioner of Health that said, ‘Settle this thing, already,’ maybe it would help.”

The New York Department of Health, though, said that its powers are limited.

“The Department does not have the authority to require a health plan and a provider to enter into or continue a contract. However, we are working with the parties to quickly reach an agreement that ensures plan members have adequate access to covered services,” said Jonah Bruno, director of public information at the Department of Health, on Monday.

Abrahamson said she hopes that both parties find a way to negotiate a contract that makes sense.

“They’re in the business to serve patients,” she said. “They’re putting profit over people.”

Liz Donovan is a Report for America corps member.