New Yorkers insured through UnitedHealthcare and Oxford Health Plans could soon lose most in-network coverage at Mount Sinai Health System, unless Mount Sinai and United resolve a dispute over the cost of medical services before the new year.
Emergency care at Mount Sinai hospitals would remain covered at in-network rates, but pre-planned visits would not. That means United members — including those covered through Oxford, which United owns — could have to pay out of pocket if they want to schedule procedures at Mount Sinai Morningside, Mount Sinai Brooklyn or the New York Eye and Ear Infirmary, among other facilities.
Mount Sinai’s network of doctors would remain in-network with United, according to Mount Sinai. But the change could make it difficult for those doctors to refer patients to Mount Sinai hospitals for follow-up care.
The current contract between Mount Sinai and United is set to expire at the end of 2023. If negotiations break down, some members will not feel the effects until March, because of a state-mandated “cooling off” period, according to United. MedicareAdvantage plans would not be affected by the change.
United Healthcare has posted on its website that Mount Sinai is proposing “outlandish” price hikes for medical services that could drive up insurance costs for both patients and employers. Mount Sinai has countered that United currently pays about 30% less for its services than it pays comparable hospital networks in the area.
“We urge the health system to approach the negotiating table with a realistic proposal New Yorkers and employers can afford,” United spokesperson Cole Manbeck said in a statement.
A Mount Sinai spokesperson said Tuesday that there is still hope that a last-minute deal can be reached.
“For several months, Mount Sinai has been working in good faith with United Healthcare, which also owns Oxford Health Plans, to establish a new, fair agreement that will put patients first and protect patients’ ability to choose Mount Sinai for care and we hope to reach a new agreement before the end of 2023,” spokesperson Lucia Lee said in a statement.
Hospitals negotiate different rates for their services with each individual insurance plan. At Mount Sinai Morningside, for example, the total cost of an appendectomy — including both the patient’s payment and the insurer’s — can vary from about $6,000 to nearly $36,000, depending on which insurer is paying for it, according a recent report from the group PatientRightsAdvocate.org. The group advocates for price transparency in health care. Prices for the same service can also vary widely between hospitals in the same area.
United is the United States’ largest insurer and has about 1.3 million members in New York City. Some 27,000 United members received services at Mount Sinai hospitals over the past year, the insurer told Gothamist.
Many of United’s members receive insurance through their employers.
“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,” United said on its website.
But Mount Sinai has pointed out that it is ultimately up to United whether to pass higher costs on to businesses and consumers.
Mount Sinai’s proposed price hikes come as the health system is also taking cost-cutting measures, including an effort to close Beth Israel hospital in Downtown Manhattan.
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