GRAMERCY, Manhattan (PIX11) -- Unless a last-minute deal is struck, one of the nation's largest health insurance companies will no longer cover one of the city's most prominent hospital networks.
Come Jan. 1, patients with UnitedHealth Insurance and Oxford Health Plans will no longer be covered in-network for services at Mount Sinai hospitals.
The back-and-forth over money could mean patients pay the highest price.
"Where am I going to go after this," pondered Wayne Eberson as he was leaving Mount Sinai Beth Israel after a brief hospitalization.
He was stunned to find out his UnitedHealthcare coverage would no longer be accepted in-network here in the new year due to an ongoing dispute over reimbursements.
All his doctors are with Mount Sinai, and while physician services will not be affected by the fight, all procedures and special referrals tied to the hospital could become out of network in the new year, costing much more.
This also applies to Oxford Health Plans, which is owned by United.
"I'm going to have to look for another location," said Eberson.
Mount Sinai said the dispute comes down to wanting to be paid fairly, claiming United reimburses them at 30% less than other local hospital systems. Here is the hospital system's full argument:
United said it offered rate increases, and Mount Sinai wants 50% more than it's currently getting paid.
Here is United's full argument: What do patients need to know?
- The fight applies to hospitals, not physicians, so for now keep those appointments in the new year.
- New York law requires a "cooling off period: that runs through Feb 29, designed to bring everyone back to the bargaining table.
- The law also dictates any insurance must be accepted in the event of an emergency, regardless of network status
- The fight is likely to cost consumers more. Both parties accuse the other of trying to drive up the costs of insurance payments and out-of-pocket payments.
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