May 3, 2021

Sympathy Does Not Make It Right - The Fight for Healthcare Amid UHC & Montefiore Dispute

by UNHP

There is still apparently no agreement to restore the network relationship between United Healthcare (UHC) and Montefiore Health System. There is no indication that negotiations are occurring at this point.

UNHP, Fordham Bedford Community Services, Fordham Bedford Housing Corporation, and Concourse House with employees affected by this impasse, have sent a letter to NYS DOH and the Department of Financial Services requesting their intervention.

May 3, 2021

Commissioner Howard Zucker

NYS Department of Health

Superintendent Linda Lacewell

Department of Financial Services

Commissioner Zucker and Superintendent Lacewell,

We are requesting that the Department of Health and the Department of Financial Services intervene in the UnitedHealthcare-Montefiore network contract dispute; we urge you to immediately re-instate the 60-day cooling-off period and to urge both parties back to the negotiating table. We are also asking you to protect us against similar problems in the future when insurers and medical organizations negotiate contract renewals.

We work with a network of Bronx non-profit groups that have had our health plans with UnitedHealthcare/Oxford for many years. As Bronx-based organizations, many of us utilize Montefiore doctors and facilities for our health care. When we renewed our UHC contract on September 1, 2020, we were unaware that Montefiore’s network contract with UHC was expiring on December 31, 2020. We received notification from UHC about a month before the end of the year that the contract was endangered. When the contract was not renewed, we received word from UHC in January. In the midst of the pandemic, many people’s long term relationships with their doctors were disrupted.

We have been writing to UHC and Montefiore since then urging them to renew their contract. We have contacted the Governor’s office, the Attorney General’s office, the Department of Financial Services and many of our state and federal elected officials. On April 16th, we received a letter from Ms. Bentley in the Department of Health saying that the department cannot intervene since this is a contractual matter outside of DOH’s regulatory authority. The letter also references a 60 day cooling off period that ended on March 1, 2021 that would “allow members to continue receiving services from the provider”. After checking with the people on our plan, we have not found anyone that was aware of or able to utilize this 60 day cooling off period to keep seeing their Montefiore doctors until March 1. One of the most common complaints has been that our staff and their families have not been able to see their Montefiore doctors and pediatricians since the contract ended at the end of 2020. When people contacted their doctors, no one was informed by their doctors or pediatricians that they could have continued seeing them until March 1.

As a result, we are asking the Departments of Health and Financial Services to require UHC and Montefiore to immediately re-instate the 60 day cooling off period to allow people to utilize their doctors and pediatricians for an additional 60 days and allow for an orderly transition to new medical practices if UHC and Montefiore cannot reach a new agreement.

While UHC and Montefiore urge us to either find other doctors or other health plans, we recognize that the exact same thing could happen to us again next time we renew our plans whether we switch plans or doctors. The Departments of Health and Financial Services need to develop a plan to protect people from this volatile future. We had no way of knowing that the UHC and Montefiore contract was up for renewal four months after we signed a new contract with UHC. The chaos that this has caused in people’s health care has been incredible. We urge you to require that network contracts be honored for those insured under employer plans until the end of the employer plan contract.

If you need additional information, please contact me at jim@unhp.org.

Thanks for your attention.

Jim Buckley

Executive Director, University Neighborhood Housing Program

John Reilly

Executive Director, Fordham Bedford Housing Corporation

Manuela Schaudt

Executive Director Concourse House

John Garcia

Executive Director Fordham Bedford Community Services




Background information:

As the first quarter of 2021 comes to a conclusion, there is still apparently no agreement to restore the network relationship between United Healthcare (UHC) and Montefiore Health System. There is no indication that negotiations are occurring at this point. Someone has suggested that the organizations will be reviewing the financial impact this split has had in the first quarter and that may determine the urgency with which negotiations are pursued.

Those who have coverage with UHC and medical care with Montefiore doctors, specialists, or facilities don’t need to wait for a report to describe the financial and health impacts that this split has caused. The press reports that the number of people affected is approximately 60,000, many in the Bronx and Westchester. Without doing much to raise awareness of this problem, we have heard from a lot of people who have been affected. Finding new doctors, renewing prescriptions, making arrangements for new surgical needs are all stories we have heard from people with whom we work and people that we know in the Bronx and Westchester. Some people continue to be surprised to find out that their doctor is no longer in network.

Several Bronx groups, including University Neighborhood Housing Program, have repeatedly contacted both UHC and Montefiore directly to urge them to work out their differences. We have heard from representatives from both expressing their sympathy and explaining that they have not been able to reach an agreement because the other side is unreasonable. We’ve explained that sympathy doesn’t make our health issues go away. While the conversations have been courteous, they have not brought results.

We are aware that a number of our elected officials have spoken out and/or have written letters to UHC and Montefiore. Representatives Bowman, Espaillat, Jones, Ocasio-Cortez and Torres co-signed a letter to both back in January; Assemblyman Dinowitz wrote a letter to both; Congressman Torres and Bronx Borough President Diaz had separate press conferences; Senator Biaggi asked the NYS Superintendent of the Department of Financial Services Linda Lacewell about it; the Superintendent said she had reached out to both CEO’s to urge them to work it out. There has been little media coverage by CBS, NY1, and the Daily News.

Still, nothing has worked thus far. The effort will continue, but the fact that there has been so little progress is troubling for a few reasons in addition to the obvious health implications for the individuals caught in the middle.

First, the assumption that having health insurance through your employer allowed you to feel comfortable with affordable and reliable health coverage has been undercut. The fact that this has happened now with a major insurer and a major hospital system makes one wonder whether any coverage is in fact reliable and any relationship with a doctor will last. It has led to spending time learning more about the proposed NY State Health Act and federal proposals for Medicare for All.

Second, the fact that the intervention of elected officials at the state and federal level has not had an impact suggests a lack of accountability in the country’s health and insurance industry.

Finally, the lack of media coverage about this battle is puzzling. 60,000 people in New York City and Westchester left in uncertainty about their health insurance and their doctors in the middle of a pandemic seems like it would merit some attention. Is the issue really too complicated for the press?

We don’t give up easily in the Bronx. We’re going to keep battling until we get a resolution that works. Stay tuned as we increase our efforts in the coming days and weeks.

Tags:

Bronx, Healthcare
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