Views from the Northwest Bronx

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

Update July 2021

UNHP has used our blog to share our ongoing struggles to keep our staff, the staff of other Bronx non-profits as well as the thousands of Bronx residents insured under United Healthcare with their Montefiore doctors. We’re more than 6 and a half months into 2021 and UnitedHealthcare (UHC) and Montefiore have still failed to renew their network contract. It’s impossible to tell if either party can claim to have won anything in this battle. However, we can identify a number of people who have lost something:

1. The people who use Montefiore doctors and have UHC health insurance; a number of those people told their stories to City Limits, the Daily News, NY1 and through comments on social media serving as representatives for thousands who could no longer see doctors and specialists that in some cases they had seen for decades
2. The employers (like UNHP) who paid for a health insurance plan for their employees and saw so many of their staff unable to get care from their trusted physicians
3. Governor Cuomo and the State Departments of Health and Financial Services who have been exposed as unable to protect, even in a pandemic, the interests of New Yorkers who lost their primary care doctors and specialists;
4. Elected officials at the federal and state level urged both parties to negotiate and were ignored.

This issue was forced on us. As a Bronx-based employer, we have provided health insurance with UnitedHealthcare through an annual contract that we have renewed on September 1 for many years. As Montefiore kept expanding in the Bronx, most of our staff, neighbors, and people we serve utilized Montefiore doctors and facilities. When we got the word in late November 2020 that the UHC-Montefiore contract was expiring on January 1, we and many experts thought the contract face-off between UHC and Montefiore would be resolved quickly and the impact would be a minor inconvenience to the people with UHC coverage and Montefiore doctors. We were so wrong.

As time passed in January, we repeatedly reached out to UHC and Montefiore urging them to settle their differences. We reached out to Governor Cuomo, state and federal legislators, regulators, and the press. We were naive enough to believe that especially in the middle of a pandemic, two major health organizations would be able to work something out to keep 60,000 people insured with UHC with their Montefiore doctors and facilities. Instead, people like us were being told to find a new health plan or new doctors. It seemed like there should be a way to get the state involved to help push them to reach an agreement.

To date, nothing has worked. We haven’t been able to figure out why there appears to be no willingness to enter into real negotiations and both have worked hard in social media to pin the blame for the failure on the other party. While expressing sympathy for our plight, both parties stopped communicating with each other. At the same time, UnitedHealth Group, the parent organization of UnitedHealthcare, has seen its stock price rise since early January from $349 to $409 per share. Meanwhile, according to Crain’s, Montefiore had a $63.6 million revenue deficit in the first quarter of 2021.

As an organization, we have used the time to explore our insurance options. Getting people’s doctors available to them again is a priority, so we will likely be changing our insurer on September 1, 2021. However, as a responsible employer and a Bronx organization, we cannot/will not stop working on this issue. This could happen next year with another insurer and medical provider.

We’re learning from our experiences these past 6 months and gearing up for a new round of work on health insurance and health care. Here is what we have learned:

• We do not have as much governmental protection as we thought we did. We thought that the New York State Departments of Health and Financial Services were supposed to be able to protect us; they didn’t. They could not “intervene in a contractual dispute” just because we were saying that we were being unfairly treated and our health was being jeopardized.
• There was no way for employers like us to have known that the network contract between Montefiore and UHC was expiring 4 months after we signed a one-year contract with UHC. Apparently, the surprise loss of our ability to go to our doctors using our health insurance also did not qualify as a problem for which they could intervene.
• NYS law requires a 60-day cooling-off period to maintain certain services while both parties have more time to negotiate. When we pointed out that we did not get those 60 days to see our doctors, we learned that the cooling-off period only applied to hospital care and that the legislation was up for renewal by the end of June.
• The health industry does not have much respect for the Governor, the state regulatory agencies, and our federal and state elected officials. UHC, one of the largest insurers in the country, and Montefiore, one of the largest hospital systems in New York City, have not felt the need to be responsive to our elected officials and the regulatory agencies. Department of Financial Services Superintendent Linda Lacewell said at a public hearing that she had reached out to both companies unsuccessfully urging them to negotiate. Both parties clearly felt that there was no downside to ignoring the State of New York and the congressional delegation.
• It is difficult to get press attention. While very grateful for the coverage from the Daily News, City Limits and NY1, we still think that the issue merited more coverage.

While we work to restore our staff’s access to their Montefiore doctors with our insurance, we are going back to our state legislators to get new legislation written to give people better protection in these health insurance company and health care provider network battles. We’ll start with the cooling-off period and push to get it expanded to include people’s doctors and extended from 60 to 120 days; we also want protection for companies with health insurance contracts that run longer than an expiring network contract. We want the New York State Departments of Health and Financial Services to be authorized to do a health impact assessment of the failure of a network contract to be renewed.

We are also going back to our federal legislators to ensure that the White House’s recent Executive Order on Promoting Competition includes looking at what is happening here in the Bronx as a result of this UnitedHealthcare and Montefiore dispute. The Executive Order frequently references health care and pharmaceutical costs. What has happened here over these first 6 months with UHC and Montefiore is a preview of things to come with other insurers and hospital systems around the country and should inform the work resulting from this Executive Order when considering health care and health insurance.

For those familiar with UNHP, you know we don’t start working on an issue if we don’t plan on staying with it until we see results. Most of our results come in the area of affordable housing preservation and bringing resources to Bronx residents. 2021 led UNHP to begin working on a new issue—health insurance and health care. The devastating consequences of the pandemic on Bronx residents highlighted a number of long-standing issues and the need for access to healthcare. UNHP and our staff thought that with insurance we would have ongoing access to care - we did not. The failure of UnitedHealthcare and Montefiore to renew their network contract threw our own health insurance plan into a state of confusion. While exploring the issue and pushing both organizations to work out their differences, we were not successful at getting them to renew their network contract. What we learned along the way has been troubling and we have begun working to get legislation written to provide greater protection for people caught in the middle of these disputes. We’ll keep you posted on our blog; if you’re interested in hearing more about the issue or want to share your story with us, please contact us Jim@unhp.org