Hospital vs. Insurer Dispute Could Force Thousands to Switch Doctors

Stalled contract negotiations between UnitedHealthcare, the health insurance giant, and Mount Sinai Health System, a leading New York City hospital system, are forcing tens of thousands of New Yorkers to switch doctors or risk paying out-of-network prices.

The impasse has dragged on for months. Mount Sinai has sought to raise prices significantly, but the insurance company has refused to agree to pay the new proposed rates. As a result, Mount Sinai’s hospitals are now out of network for patients insured by UnitedHealthcare or Oxford, which are subsidiaries of the same company.

But the issue is about to become even more urgent for many patients because many Mount Sinai affiliated doctors — in addition to the hospitals themselves — are about to be removed from UnitedHealthcare’s network, starting March 22. That means patients with United who have employer-sponsored or individual plans will be billed out-of-network rates when they see a Mount Sinai affiliated doctor at a doctor’s office.

The negotiations have sent many patients scrambling to find new doctors. UnitedHealthcare says about 80,000 Mount Sinai patients are affected.

What Happened?

The dispute between the insurance giant and the hospital system is a rare instance in which health care contract negotiations have spilled into public view.

Mount Sinai sought to negotiate better rates with UnitedHealthcare, demanding that the insurance giant pay the hospital more for doctor visits and hospital stays. United claims Mount Sinai was asking for rates to go up some 58 percent over the next four years.