Mount Sinai and UnitedHealthcare reach deal

UnitedHealthcare and Mount Sinai reached a contract agreement Tuesday, days before thousands of physicians affiliated with Mount Sinai were slated to leave the health insurer's commercial network on Long Island. 

Amid a dispute about reimbursement rates, UnitedHealthcare and Mount Sinai, a Manhattan-based health system, broke off their contract in late 2023. They initially told patients that the lower, in-network rates would remain available at Mount Sinai hospitals under most plans until March, thanks to a mandated cooling-off period. Patients then learned that many Mount Sinai physician would also stop being part of UnitedHealthcare's commercial network on Friday. They scrambled to secure medical appointments and doctors' recommendations before the shift. 

“I am very relieved,” said John Patti, 74, of Merrick, who was worried about replacing a urologist who had treated him for a decade and higher rates at Mount Sinai South Nassau hospital.

UnitedHealthcare said it had reached a multiyear contract with Mount Sinai, bringing the health system's hospitals back into its network and ensuring continued access to its physicians.

Mount Sinai previously said UnitedHealthcare paid it an average of 30% less than other academic medical centers in New York. The insurer responded by saying Mount Sinai requested “outlandish” increases that would strain the small businesses that insure workers with UnitedHealthcare's Oxford policies. Now that an agreement is in place, neither organization answered questions about what type of reimbursement rates it contains.

Mount Sinai previously told Newsday nearly 15,900 Long Island residents could be impacted by the split. This included UnitedHealthcare members who have insurance through an employer or who purchased a private plan on the state's exchange, UnitedHealthcare said.

About 4,500 physicians on Long Island have attending rights at Mount Sinai hospitals, the health system said. During the impasse, these physicians could remain in UnitedHealthcare's network if they were credentialed at another hospital that is part of the insurer's network — or if they got credentialed at such an institution.

But that would not have been a practical move for many physicians, according to Dr. David Podwall, a neurologist and president of the Nassau County Medical Society, a physician trade group.

“It is really a game between these two huge systems, but who is suffering is the patients,” Podwall said, noting that even before this market disruption, many patients had to contend with waitlists. “They either can't get their care or they're going to go bankrupt getting their care.”

Some Long Islanders have already spent days trying to sort out where the dispute left them. Patti learned about UnitedHealthcare network changes when his urologist's office called, and he managed to move up an April appointment to avoid possible higher, out-of-network bills. Patti wanted to get a recommendation for a new urologist from Dr. Michael Herman, who has been treating Patti's prostate issues and chronic kidney stones for a decade. 

His daughter-in-law, Gabriella Patti, 31, found herself in a similar position and quickly booked appointments with her gastroenterologist. She has an autoimmune disease and was trying to assess whether she should try to switch to a Cigna plan — her employer offers policies with both insurers. 

The bigger concern, according to John Patti, was Mount Sinai South Nassau hospital dropping out of the insurer's network. Although emergencies must be billed with in-network rates, Patti said he isn't sure what would qualify as an emergency: would developing a kidney stone?

“South Nassau really is our hospital in the area here,” said Patti, a retiree, who is on a policy through his wife's employer, American Airlines. 

It's “not uncommon” for insurer and provider disputes to escalate and destroy existing contracts, according to Krutika Amin, associate director of the Program on the Affordable Care Act at KFF, a nonpartisan health policy research group. But splits among insurers and small family practices don't attract as much attention or have as widespread of an impact, Amin said. 

Two factors likely fueled the conflict between Mount Sinai and UnitedHealthcare: inflation pushing up hospital wages and expenses, and health systems having a better sense of their competitors' reimbursement rates under fairly new price transparency measures, Amin said.

Some state-level analyses suggests that the price disclosure rules may inflate health insurance premiums, but evidence on that is mixed and evolving, Amin said.

“Providers can demand higher prices, so prices may go up or premiums may go up,” she said. “On the other hand, insurers are also finding out what other plans are paying providers, and can try to put down more pressure. We don't really have national data on how everything is going to shake out.”

By Sarina Trangle

sarina.trangle@newsday.comSarinaTrangle

Sarina Trangle covers affordability and cost of living issues and other business topics. She previously worked as an editor and reporter at amNewYork.