As the deadline for United Healthcare to renew its agreement with Montefiore has passed there are now more than 60,000 patients without access to doctors to at Montefiore.
On Wednesday, Borough President Ruben Diaz Jr. called for United Health come to the table, put greed aside and shown good faith in negotiations.
As of Jan. 1, the contract between United Healthcare and Montefiore expired without a new contract in place to cover the care that Montefiore provides to patients with United/Oxford commercial health plans, United Medicaid Community Plans and United Medicare DSNP Plans.
As a result, many Bronx, Westchester and Rockland County residents have lost their in-network access preferred Montefiore doctors and hospitals in the middle of a global pandemic. Diaz wrote a letter to United in October, but received a very perfunctory response.
“The patients enrolled in that network now find themselves in a dire situation” he said. “For patients this is a devastating outcome.”
In December, Congressman Ritchie Torres urged United to keep its partnership with Montefiore.
Montefiore Medical Center is in contract negotiations with United Healthcare concerning health coverage and premium payments, yet United Healthcare refuses to come to the negotiation table in good faith and is putting patients at risk of losing coverage. In the first three quarters of 2020, when the pandemic was ravaging the Bronx, United Healthcare made over $15 billion in profits and yet it is unclear if those profits are being used to improve patient healthcare.
Montefiore is only asking for rates that will put United on the same level as other insurance payors. It serves a population made up of over 85 percent of patients covered by Medicare or Medicaid. With these numbers continuing to increase because of the pandemic, the hospital doesn’t have the resources to cover $300 million plus in incremental pandemic related costs while payors or United profit.
Diaz stressed that in a borough that has been hurt badly by COVID-19 Bronxites need insurance more than ever. He feels this leaves them with three options: pay more to see a Montefiore doctor, find a new one or the most dangerous one, not see a physician at all.
“They (Montefiore) need more resources to continue to provide quality health care for the people of the borough,” he stressed. “It’s even more inexcusable to do this against the poor and working class during this pandemic. Montefiore has been a friend of Blacks and Latinos. Montefiore knows the community. So we trust their services.”
Among the people affected by United not renewing its partnership with Montefiore is Bronx resident Amy Martinez. Martinez has been seeing doctors at Montefiore for several years and is quite upset.
“United Healthcare needs to work with Montefiore and reach an agreement,” she exclaimed. We are living in unprecedented times and health care is needed more than ever. United needs to show they care and be on right side of history.”
A United Health spokesman expaliend that United offered to increase the rates it pays all of Montefiore’s hospitals, despite its position as the most expensive health system in New York City.
It provided Montefiore with four formal proposals from Oct. 23 to Dec. 29 and made numerous compromises. However, little progress was made, as Montefiore refused to move off its demand for approximately 9 percent annual rate increases, which equated to a nearly 30 percent price hike over three years.
Agreeing to Montefiore’s demand would have increased health care costs by more than $200 million for New York families and employers.
“We offered to allow our members to have network access to Montefiore’s hospitals and physicians through May 31, 2021, while we continued our efforts to renew our relationship,” the spokesman said. “Unfortunately, Montefiore refused, unnecessarily disrupting access to its hospitals and physicians for thousands of New Yorkers. Our top priority at this time is ensuring our members have access to the care they need and supporting them as they transition to one of the dozen hospitals and nearly 7,000 physicians remaining in our network in Bronx, Westchester and Rockland counties.”
The timing of when United members will lose in-network access will depend on the type of plan they’re enrolled in:
- Employer-sponsored self-insured (ASO): Montefiore physicians and hospitals out of network, effective Jan. 1,
- Employer-sponsored and individual fully insured plans, including Oxford: Montefiore physicians out of network, effective Jan. 1,; Montefiore hospitals out of network, effective March 1,
- Community Plan (Medicaid): Montefiore physicians out of network, effective Jan. 1, ; Montefiore hospitals out of network, effective March 1,
- Medicare Advantage Dual Special Needs Plan (DSNP): Montefiore’s hospitals and physicians out of network, effective April 1,
- Medicare Advantage Institutional Special Needs Plan (ISNP): Montefiore physicians out of network, effective April 1,
There was also an agreement on Medicaid rates for months and United proposed to Montefiore that they finalize that contract so Medicaid members could continue accessing Montefiore’s hospitals and its physicians.However, Montefiore did not oblige.
