Mount Sinai, UnitedHealthcare publicly spar over contract negotiations

 Yet another notable payer-provider contract negotiation is going public.

As of Jan. 1, New York City-based health system Mount Sinai is no longer in-network for UnitedHealthcare's employer-sponsored and individual market plans, including plans offered through its Oxford brand.

In a statement, the health system said that the insurance giant underpays for its services compared to other providers in the region. Mount Sinai said it's paid 30% less on average for the same services, and for some care is paid 50% less than its peers.

"We are disappointed that United Healthcare and Oxford have threatened to limit access to Mount Sinai Hospitals and physicians," the system said in the statement. "Mount Sinai must be paid fairly. As Mount Sinai costs substantially less than our peers, UHC/Oxford will actually end up paying more for patients to get care at other systems in New York."

The system said that care provided at other facilities would cost an estimated $140 million more, which would be passed on to patients and employers.

"Mount Sinai is already—and is proud to remain—the best value for high-quality care for all New Yorkers," it said.

UnitedHealthcare, meanwhile, charges that Mount Sinai is seeking a pay hike that would significantly drive up costs. The insurer said in a statement that the system is asking for a price increase of nearly 50% over the next three years, which would add $600 million in healthcare costs.

The changes, according to UHC, would make Mount Sinai hospitals "the most expensive in New York City by a considerable margin."

"We remain committed to continued discussions with Mount Sinai should the health system provide a realistic proposal New Yorkers and employers can afford," UnitedHealthcare said. 'However, our top priority at this time is ensuring the people we serve have access to the care they need through either continuity of care or a smooth transition to a new hospital.” 

UHC said its existing contract with Mount Sinai, which was put in place in 2022, included market-competitive rate increases each year. After about 20 months in the agreement, the health system requested significant payment increases, including a 70% overall price increase for services at its flagship facility, Mount Sinai Hospital.

The dispute does not impact network coverage for Medicare Advantage or Medicaid, and the system's physicians will remain in network for all plans, UnitedHealthcare said. People in fully insured commercial plans will have access to Mount Sinai's hospitals in-network through Feb. 29, per state regulations.

Members in self-insured plans, meanwhile, will have access to Mount Sinai Hospital and Mount Sinai Hospital of Queens in-network until Feb. 29.

To assist patients with continuity of care, both Mount Sinai and UnitedHealthcare have launched a website to assist.

https://www.fiercehealthcare.com/payers/mount-sinai-unitedhealthcare-publicly-spar-over-contract-negotiations