December 2, 2021

UHC & Montefiore Sign Contract but Healthcare Access Problem is Far from Solved

by UNHP

The December 1st Renewal of the UnitedHealthcare and Montefiore Network Contract Does Not Solve the Problem

UNHP Proposal for Reform of Current Procedures on Health Insurer and Hospital System Contract Negotiations:

On Wednesday, December 1st, Montefiore will be back in the UnitedHealthcare network. After 11 months of disrupted health care for approximately 65,000 people in the Bronx and neighboring counties with UHC health plans and Montefiore doctors, this is good news. However, we can’t celebrate and move on; this never should have happened in the first place. For 11 months, in the middle of a pandemic, one of the largest insurers in the country and the largest hospital system in the Bronx could not reach an agreement to maintain coverage for thousands of people to maintain access to their UHC health insurance with their Montefiore doctors… and seemingly no city, state or federal regulation or legislation was in place to stop this from happening.

It should never have been allowed to happen. Yet, we are headed in a direction where this will happen repeatedly in the future. UNHP is working to see immediate action on a legislative and regulatory level to provide better protection for people in situations like this.

  • First, under current law, when a contract terminates between an insurer and a hospital system, they are required to have a 60-day cooling-off period to allow people to maintain health coverage at affected hospitals while a deal may get finalized. This does not apply to people’s doctors and specialists. We are proposing that the cooling-off period applies to doctors as well as hospitals. We have also called for an increase of the cooling-off period to 120 days.
  • Second, we are calling for New York State to require a community health impact analysis prior to the termination of a contract between an insurer and a hospital system. The reason is clear: the Bronx had already been heavily impacted by the pandemic and suddenly on January 1st, 2021 thousands of Bronx residents lost access to their long-term doctors and specialists. All of the state agencies that oversee health insurance stated that they had no authority to intervene in a “contractual dispute”. The UHC-Montefiore dispute was much more serious than a “contractual dispute”.

We appreciate that the availability and affordability of quality health care for New Yorkers extends far beyond this one problem. We have seen steadily rising premiums while we accepted increased deductibles, copays, and ‘out of pocket’ limits. The proposals described above do not address these other items. But this UHC-Montefiore network contract issue has motivated UNHP to begin to work for the first time on health insurance. As we have publicized our concerns, we have heard from a wide variety of our colleagues and neighbors who have also been tolerating this steady deterioration in health coverage over the years.

This process has led us to learn about the proposed New York State Health Act and to explore how this proposal could improve health care and health insurance in New York State. We believe the proposals we have made could provide some immediate assistance, while at the same time using the UHC-Montefiore dispute to build greater awareness about the issue and even fueling hope that these trends can be reversed. The shock, frustration, and anger of people who previously believed they had adequate health insurance coverage, to allow them to continue going to see their long-term family doctors and specialists, has been turning into action and hope for change. UNHP comes from a history of community organizing in the Bronx that worked building by building to address problems of disinvestment. We view this as our first step in addressing health policy.

How UNHP became involved

This issue was forced on us. On September 1, 2020, UNHP renewed our employer health plan with Oxford / UnitedHealthcare (UHC). As a Bronx-based employer, we have provided health insurance via a health insurance contract with UnitedHealthcare for many years. As Montefiore kept expanding in the Bronx, most of our staff and many neighbors and people we serve utilized Montefiore doctors and facilities. In late November, we were informed by UHC that their network contract with Montefiore was expiring on January 1, 2021. We and many people in the industry thought the contract face-off between UHC and Montefiore would be resolved quickly and the impact would be a temporary inconvenience to the people with UHC coverage and Montefiore doctors.

As “temporary” turned into two weeks, we began contacting Montefiore and UHC urging them to “work it out”. Both sides blamed the other for the impasse and recommended either changing insurers or doctors. As time passed in January, we repeatedly reached out to UHC and Montefiore urging them to settle their differences. 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 $444 per share on November 30 (https://www.cnbc.com/quotes/UNH). Meanwhile, according to Crain’s, Montefiore had a $129 million revenue deficit in the second quarter of 2021, and Becker’s Healthcare confirmed significant losses in this article.

We contacted the media. We wrote about the fact that the Bronx was already being hard hit by the pandemic and this was compounding the negative impact of people losing their Montefiore family doctors and specialists; and, the difficulty of trying to find and get appointments with new doctors that our plan would cover. The Bronx Congressional delegation wrote a letter to both groups. Individual members of the State Assembly and State Senate wrote letters. All three state agencies told us that they could not intervene in a “contractual dispute”. Several reporters (Jarrett Murphy and Liz Donovan of City Limits, Larry McShane of the NY Daily News, Amy Yensi of NY1) did stories, but nothing changed.( These stories can be found here on UNHP’s Press page)

We contacted state and federal legislators; we contacted NYS agencies — the Attorney General, the Department of Financial Services and the Department of Health. But we discovered that 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. When politicians and public agencies did issue public statements, it became clear that 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 ( Bottom of page at 1:47. 46) 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.

We also discovered that 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. What’s more, 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.

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.

What We’ve Learned

For UNHP, when our health insurance contract with UHC came up for renewal on September 1, we switched insurers to a company that included Montefiore in their network. However, we recognize that this same situation could happen to us again with the new company. As detailed above, we are discussing legislative and regulatory reform with two Bronx State Senators and one Assemblyman that would expand the rights of people who are caught in the situation we just experienced. We’ve learned a few things along the way that we are hoping to pass along to others:

  • First: We can’t take our insurance and doctors for granted; while health experts call for people to maintain a relationship with a Primary doctor, that relationship can be taken away in a split second based on the financial negotiations between the hospital system and insurer.
  • Second: We can’t depend upon existing legislation or regulation for protection; in the middle of a pandemic, we could not get assistance from the NYS Office of the Attorney General, the Department of Health, or the NYS Department of Financial Services; all we heard was that they could not intervene in a “contractual dispute”.
  • Third: Neither the insurers nor the health systems were responsive to appeals from federal or state legislators. Clearly, neither believe that they have to worry about legislative action to change this current situation.
  • Fourth: The issue is so complicated that it makes it difficult to get enough press coverage. With some notable exceptions, we were not able to get much coverage.
  • Final: This is only going to get worse unless we do something.

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. 2021 led UNHP to begin working on a new issue—health insurance and health care. 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 welcome those who want to join us in this fight and/or to share their own story.

Tags:

comments powered by Disqus