Some One Medical patients may soon lose affordable access to their doctors because of an ongoing clash between a preeminent New York hospital system and the country’s biggest health insurer.
For months, Mount Sinai Health System and UnitedHealthcare have been fighting over payments. Mount Sinai wants more money for its services, and UnitedHealthcare refuses to increase its rates to the level Mount Sinai is requesting.
Mount Sinai ended its contract with the insurer, so UnitedHealthcare members can no longer get care at its hospitals without paying higher costs. By the end of the month, members won’t be able to see Mount Sinai doctors either.
On March 12, One Medical, the primary care company owned by Amazon, told patients that its providers in New York City may no longer be covered by UnitedHealthcare starting March 22. If that happens, patients with that insurance who continue to see their One Medical providers would be on the hook for bigger bills.
One Medical said in an email to patients that it’s opening up availability so affected members can schedule appointments before they lose access.
“Our members’ access to high-quality care is our No. 1 priority. We are deeply disappointed by this situation and are exploring every avenue to limit disruption to your care,” One Medical said in the email reviewed by Business Insider.
A One Medical spokesperson reiterated that message in an emailed statement. One Medical is affected by the dispute because it’s part of Mount Sinai’s clinically integrated network and provides services consistent with Mount Sinai’s contracts with insurers, the company said.
A UnitedHealthcare spokesperson said about half of One Medical’s providers will remain in the insurer’s network beyond March 22 because they have admitting privileges to another in-network hospital. UnitedHealthcare members will be able to continue seeing those providers for in-network care, he said.
Contract disputes between insurers and providers are common
Health insurers and providers spar over payments all the time. Across the US, hospitals’ costs for labor and supplies have been increasing. Because current contracts formed during the pandemic don’t account for those unanticipated costs, hospitals are going back to the insurers to ask for higher rates, said Meggi Carr, an analyst at Fitch Ratings.
Typically, these types of disputes get resolved in the final hour. The dispute between UnitedHealthcare and Mount Sinai is somewhat unusual because the system’s hospitals have already left UnitedHealthcare’s network. Mount Sinai is also asking for higher rates in the middle of its three-year contract, which isn’t typical, said Fitch analyst Brad Ellis.
Mount Sinai says on its website dedicated to the dispute that it’s been working to reach a new agreement with UnitedHealthcare since May 2023, but the insurer has refused its “good faith attempts to collaborate.” In an email, a Mount Sinai spokesperson said that UnitedHealthcare pays it 30% less on average than other hospitals in New York and 50% less for “many procedures.”
“For years we have been paid far below our competitors in New York City. UnitedHealthcare is blatantly misrepresenting the facts. Mount Sinai is simply asking to be paid fairly and well below our higher-paid competitors for the outstanding care we provide,” the spokesperson said.
UnitedHealthcare argues that Mount Sinai demanded “outlandish” price hikes that would increase healthcare costs by $574 million over the next three years. Most of those costs would be shouldered by employers and their workers, UnitedHealthcare said on its website.
“We remain engaged in active discussions with Mount Sinai and have provided the health system with multiple proposals that include meaningful rate increases that ensure they’d continue to be reimbursed at market-competitive rates,” the UnitedHealthcare spokesperson said.
Mount Sinai doctors can remain in UnitedHealthcare’s network by obtaining privileges at another in-network hospital, he added.
The spokesperson said more than 80,000 commercial members, including those who see One Medical doctors, are affected by Mount Sinai going out of network. The Mount Sinai representative said close to 100,000 patients, including One Medical patients, have been affected.
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