UnitedHealthcare and New York hospital group Montefiore Health System have reached an agreement after previously sparring over imaging costs the insurance giant said were 2-3 times the local average.
UHC cut the noted academic provider and its 85-plus radiologists out of network on Jan. 1 after the two failed to strike a year-end deal. The dispute spilled into the public eye, with both sides setting up websites defending their position and criticizing the other’s. But the two have taken those sites down and announced a pact to retore in-network access across Montefiore’s 10 hospitals and 200 outpatient facilities.
“The long-term health of our patients has always been the central focus of our negotiations,” Colleen Blye, executive VP and chief financial officer, said Oct. 28. “Over the past 10 months, the support of our local employers, elected officials and communities has been overwhelming, and we are pleased that our patients once again have in-network access to their trusted Montefiore hospitals and providers.”
About 60,000 individuals enrolled in UHC, Oxford employer-sponsored and Medical Dual Special Needs Plans will regain access on Dec. 1. The Minnetonka, Minnesota-based payer thanked its 3.7 million New York health plan members for their “patience throughout this process.”
“We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them,” UHC said on its website. “Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.
UHC earlier this year had labeled Montefiore “New York City’s most expensive health system.” A CT scan, for instance, had run $2,200 more than average in the area, while an MRI was $4,000 pricier, according to the insurer’s website. On the other side, Montefiore said it had spent $300 million on supplies and infrastructure responding to the pandemic, discharging more than 5,000 COVID-19 patients. Leaders also noted that Montefiore is in the top 15% of most cost-efficient academic hospitals in the U.S., based on Centers for Medicare & Medicaid Services data.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.