“Patients should never be the forgotten piece in a contract negotiation between healthcare entities. They should be the central focus.”
Adi Talwar
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A huge number of New York City medical patients currently face the terrifying possibility of losing their in-network healthcare coverage. United Healthcare (UHC), the largest health insurance company in the country, and Mount Sinai Health System, New York City’s second-largest hospital system, are disputing a contract renewal that would keep Mount Sinai’s hospitals within the insurer’s network.
Should UHC and Mount Sinai fail to come to an agreement before March 1, 1.3 million New Yorkers enrolled in one of the insurer’s health plans, including Oxford Health Plans, could find their existing healthcare facilities out-of-network across Mount Sinai’s hospital system. As of Jan. 1, several of Mount Sinai’s hospitals have already been designated out-of-network by UHC, due to the ongoing issues. If an agreement is not reached by March 22, all Mount Sinai hospitals and physicians would go out-of-network for those insured by UHC.
Where do patients fit into this dispute? In short, they are being left behind, with their medical uncertainty the byproduct of a contract negotiation. As these March deadlines approach, I urge both parties to find a resolution so that patients don’t bear the real harm caused by this corporate disagreement. Patients should never be the forgotten piece in a contract negotiation between healthcare entities. They should be the central focus.
When thinking about the most vulnerable victims of healthcare business disputes like these, it’s crucial to consider patients with chronic conditions such as Inflammatory Bowel Disease (IBD), which includes Crohn’s disease and ulcerative colitis. Approximately 1 in 100 Americans suffer from these diseases, requiring lifelong care and specialist healthcare providers. Finding the right gastroenterologist can often take years of consultations. Renowned academic medical centers like Mount Sinai offer expert teams of doctors, experienced in researching and treating complex conditions, which may not be available at other healthcare facilities.
To suddenly find that their preferred physicians are no longer covered by insurance is a scary prospect for patients. It may change or halt their established treatment plans, jeopardizing progress toward remission and potentially leading to dangerous health complications. For IBD patients, stress is a possible contributing factor to disease flares, compounding their suffering during an already tense time.
As the CEO of the Crohn’s & Colitis Foundation, I frequently hear stories of fear and anxiety from IBD patients regarding possible disruptions in their access to healthcare. Recently, a 29-year-old Crohn’s disease patient with Oxford Health Plans, a subsidiary of UnitedHealthcare, shared her concerns with me about losing access to her doctor, a renowned GI specialist at Mount Sinai.
This doctor is an integral part of her trusted care team, which took years to establish. Diagnosed at 13 years old, this patient has a complex 16-year medical history. As she puts it, “When you have a chronic illness, finding doctors who you truly trust and who understand your journey is really difficult and takes time to build. I’m very sad and frustrated about having to potentially leave my GI doctor and surgeon, with whom I took years to build relationships and trust.”
This patient’s experience demonstrates the toll on those forced to transition to new healthcare providers, and her story isn’t unique. Time and time again, patients get stuck in out-of-network limbo as insurers and hospitals feud over contracts. Disputes like these have only increased since the COVID-19 pandemic. For parents of pediatric patients, this predicament can be especially difficult, since pediatric medical specialists with expertise in diseases like IBD can be hard to find.
UHC and Mount Sinai have the power to make these patients’ situations easier, by coming to an agreement that ensures continued in-network access. Chronic disease patients should not have to fight for what they need to be healthy, whether it’s regular consultations, medications, or procedures.
As the patient I spoke to says, “Really the uncertainty has been the worst part.” While on her honeymoon abroad, the patient called both Oxford and Mount Sinai, only to learn that “everyone is equally confused and cannot give me a firm answer for whether my doctors or procedures will be covered after March 1.” For patients with chronic and incurable diseases like IBD, such uncertainty isn’t just physically and emotionally taxing—it’s financially taxing, too, as patients wait to find out if their care will stay in their insurer’s network.
Our country, as well as our city, need a patient-centered approach in healthcare contract negotiations. I hope for a swift agreement, similar to those UHC has previously reached with major healthcare providers, between UHC and Mount Sinai to alleviate the uncertainty facing hundreds of thousands of patients in New York City. UHC and Mount Sinai must now listen to the people they serve, find empathy, and come together to provide continuity of care to support individuals on their journey toward healing. A patient-centric approach to this dispute, and others like it, is the only way forward.
Michael Osso is the president CEO at the Crohn’s & Colitis Foundation
