Sarah Feldman, 35, began receiving unsettling letters from Mount Sinai Medical in November last year. The New York hospital system informed her of ongoing struggles in negotiating a pricing agreement with UnitedHealthcare, which includes Oxford Health Plans, Feldman’s insurer.
“We are working in good faith with Oxford to reach a new fair agreement,” the letter stated, adding reassurances: “Your physicians will remain in-network, and you should keep appointments with your providers.”
Allison Hoffman, a law professor at the University of Pennsylvania, reflected on the situation, noting that while the practice may be currently legal, it elicits a negative response. She cited a clause deep within her own insurance policy suggesting that provider-insurance contracts may change at any time.
Hoffman emphasized the lack of federal regulation regarding the continuity of coverage, particularly in defining it, leaving the matter unresolved. She speculated that the recent uptick in contract disputes between insurers and providers may stem from hospital price transparency regulations implemented in 2021, enabling hospitals to compare reimbursement rates.
Mount Sinai disclosed that it sought better reimbursement from UnitedHealthcare after discovering it was being paid significantly less than similar institutions. However, many insurers continue to pay for a period after a contract ends, typically 60 to 90 days, or complete an “episode of care,” such as pregnancy.
Erin Moses, employed by a small nonprofit, encountered a situation where her therapist group terminated its contract with Anthem due to delayed reimbursement. Left with a bill of $814, she expressed concern about the financial impact.
Patients often find themselves unexpectedly affected. Laura Alley recounted her experience after needing surgery for a broken pelvis, only to discover that the anesthesia provider was no longer in-network with her insurance, resulting in substantial out-of-pocket expenses.
Sarah Feldman, a patient at Mount Sinai, faced upheaval when the hospital system terminated its contract with her insurer. Suddenly forced to change all her doctors, including her primary care physician, gynecologist, orthopedist, and physical therapist, Feldman highlighted the added stress of navigating these changes.
One of the most frustrating aspects for patients is the inability to change insurance outside of specific enrollment periods, while insurers can modify contracts at any time. This discrepancy leaves patients vulnerable, as they often select policies based on coverage for specific providers or medications, unaware that such coverage may change mid-term.
As disputes over pricing escalate between hospital systems and insurers, patients are increasingly caught in the crossfire. Contract terminations are becoming more frequent, leaving patients scrambling to find new in-network providers affiliated with alternative hospital systems.
