Weeks before Stony Brook Medicine’s hospitals and providers were to be removed from UnitedHealthcare’s network following the expiration of a contract, the two parties have come to terms with respect to new agreements for hospital, physician, and ancillary services, according to Stony Brook Medicine officials.
As of Tuesday, however, a July 7 expiration date remains in effect “to allow the parties to complete the paperwork necessary to finalize the new agreements,” the Stony Brook officials said in a statement to The Star.
Stony Brook Medicine, which includes four hospitals, more than 200 health care practices serving Long Island, and the Long Island State Veterans Home, and UnitedHealthcare had notified the latter’s policyholders that Stony Brook’s hospitals and providers in New York State would be out of network for those enrolled in many of its insurance plans as of July 7.
In April, Stony Brook Medicine announced negotiations with United/Oxford over contracts that would determine how UnitedHealthcare and Oxford compensate its hospitals and physician medical practices for United/Oxford commercial lines of business, including employer-sponsored and professional employment organizations. An initial deadline of May 31 was extended through July 7 to allow the two parties to conclude negotiations and finalize new agreements.
The affected plans are UnitedHealthcare’s employer-sponsored and individual commercial plans, commercial plans of its Oxford subsidiary, UnitedHealthcare Community Plans, which are contracted by the state to manage health benefits for Medicaid recipients, and Medicare Advantage Plans, including Group Retiree and Dual Special Needs Plans.
As of Tuesday, UnitedHealthcare stated on its website that the insurer was “currently negotiating in good faith with Stony Brook Medicine,” with a goal to “reach an agreement that is affordable for the people and employers we serve while ensuring continued, uninterrupted network access to Stony Brook’s hospitals and physicians.”
Should new agreements not be finalized and Stony Brook leave the UnitedHealthcare network, members enrolled in UnitedHealthcare and Oxford fully insured commercial plans, Medicaid plans, and Compass/IEX (individual exchange) plans will maintain network access to all of Stony Brook’s hospitals through Sept. 5, in accordance with state “cooling off” requirements, according to UnitedHealthcare. Cooling off, however, only applies to Stony Brook’s hospitals and is only applicable for commercial and Medicare managed plans.
Stony Brook University Hospital, UnitedHealthcare notes, does not at present participate in its Medicare Advantage network. Those enrolled in its Empire Plan are not impacted by the negotiations and will continue to have access to Stony Brook regardless of the outcome.
UnitedHealthcare is “proposing meaningful rate increases that will ensure Stony Brook’s hospitals and physicians continue to be compensated at market-competitive rates” while balancing affordability for the individuals and employers it serves, according to a page dedicated to the negotiations on its website. “We have a responsibility to provide the people we serve with access to quality health care while also helping to contain rapidly rising health care costs,” it says. “Maintaining fair and competitive agreements with the hospitals and providers in our network is critical to our ability to meet this commitment for consumers and employers.”
In contrast to Stony Brook Medicine’s message, a UnitedHealthcare spokesperson said in an email to The Star on Tuesday that “we remain actively engaged in good-faith discussions with Stony Brook Medicine. It remains our top priority to reach an agreement prior to July 7 that is affordable for New York families and employers while providing continued, uninterrupted network access to Stony Brook’s hospitals and providers. We will remain at the negotiating table as long as it takes to renew our relationship.”
The Stony Brook officials advised residents to refer to stonybrookmedicine.edu for updates or call its dedicated hotline at 631-638-4013 for more information.
Should the parties ultimately fail to renew their agreement, UnitedHealthcare customers will have access to in-network care from providers and hospitals including Peconic Bay Medical Center in Riverhead; John T. Mather Memorial Hospital and St. Charles Hospital in Port Jefferson; NYU Langone Hospital-Suffolk, formerly Long Island Community Hospital, in East Patchogue; Good Samaritan Hospital in West Islip; Huntington Hospital Association; North Shore University Hospital in Syosset; South Shore University Hospital in Bay Shore, and St. Catherine of Siena Medical Center in Smithtown.
In the event of that failure, UnitedHealthcare members in the middle of treatment at a Stony Brook hospital or with a Stony Brook physician may qualify for continuity of care, which provides continued in-network benefits for a specified period after a hospital or physician leaves its network. Examples of qualifying patients include pregnant women, patients with newly diagnosed or relapsed cancer, and those currently in active cancer treatment.
According to UnitedHealthcare, in the event of an emergency, members should go to the nearest hospital, where emergency care will be covered at the in-network benefit level regardless of whether the hospital participates in the UnitedHealthcare network. To find in-network physicians, members have been advised to visit myuhc.com.
