‘They’re Freaking Out:’ Letters Warn Patients They Risk Losing Their Doctor
Mar 13, 2024
Patients are caught in the middle of contract
disputes between hospitals and health insurers
Patients
are getting ominous warnings in their mail and inboxes: They are about to lose
insurance coverage of their doctors.
The
threatening letters and emails have sent patients reeling. Unsure what to make
of it all, they are flooding doctors with calls asking questions, snapping up
appointments with the physicians and taking to social media to complain.
The
patients are caught in the middle of unusually fierce and public contract
disputes this year.
Sparring
in New York City are health insurers such as giants UnitedHealthcare and Aetna,
which pay for medical care, and big-name hospital systems like
NewYork-Presbyterian and Mount Sinai Health System seeking more money for the
treatment provided by their doctors.
At
stake for the patients if their insurer drops coverage: pay hundreds if not
thousands of dollars more out of pocket for treatment with their longtime
doctor—or find a new one.
Although
the sides usually reach agreements before a breakup, current standoffs have
resulted in some people already losing coverage, while others wait anxiously to
see what happens.
“Look
at how much pain and suffering you are causing, look at how much distress you
are causing, look at how little I am sleeping,” said Sarah Digby, who got one
of the emails on Tuesday.
Digby
sees doctors at NewYork-Presbyterian, which said in the email she may lose her
insurance coverage from
’s Aetna at the end
of May.
NewYork-Presbyterian
said the insurer has failed to offer enough. Aetna said the hospital system’s
demands are unsupportable. Both declined to say what rate increases they are
seeking.
Hospital
systems treating patients and the health insurers who pay for the care have
often wrangled over the terms of their next contract, and contentious disputes
have sometimes spilled over into public threats of lost coverage.
Yet
the standoffs, which are also taking place from Arizona to Ohio, have gained in
number and intensity this year, according to industry experts.
Higher labor
costs have prompted hospitals to insist on bigger payments. Adding to
the hardened positions of some hospitals is new pricing data, which became
public in 2021 and 2022 and can show that rivals are
getting better terms.
Patients’
growing use of medical care following a pandemic lull has increased costs for
insurers, however, and raised pressure
from Wall Street to keep a lid on spending.
For the increasing numbers of patients pulled into the
brinkmanship, the risk is creating anxiety.
If
hospitals and insurance companies fail to agree on a contract, patients can
lose not only some or even all of their health plan’s coverage, but they may also
pay a doctor’s higher, non-negotiated rates.
Digby
said her plan pays significantly less of her bills for doctors who aren’t
covered, which is known as being out-of-network.
After
getting the warning, Digby, who has a chronic condition called endometriosis
that causes pain, quickly scheduled an ultrasound and messaged a doctor to see
if she needed another procedure before the cutoff with her doctors.
“I
can’t lose them,” she said. Her doctors, she said, were able to diagnose and
treat her condition after she spent years trying to get it treated.
Typically
the sides negotiate while operating under their current contract. More talks
are deadlocking and contracts being terminated, said Kevin Holloran, a Fitch
Ratings hospital analyst.
Patients
with insurance from UnitedHealthcare, owned by
, began losing some
in-network coverage for Mount Sinai Health System in New York in January.
UnitedHealthcare
ended coverage for more Mount Sinai hospitals as of Friday, and will cut off
benefits for some Mount Sinai physicians March 22.
The
dispute, which could mean 80,000 to 100,000 patients losing in-network
coverage, boiled over after Mount Sinai reopened their contract early.
Anxious Mount Sinai patients are inundating doctors with pleas for
help and questions whether they will be able to keep seeing their doctor.
Alan
Adler, an obstetrician-gynecologist who is also Mount Sinai’s senior medical
director for physician contracting and billing, said he seeks to reassure
patients who are getting conflicting answers about coverage. “They’re freaking
out, quite honestly,” he said.
The
hospital system sought new terms because of rising labor costs and its analysis
of newly
public hospital pricing data indicated Mount Sinai wasn’t paid as well
as its competitors, said Brent Estes, Mount Sinai’s chief managed-care
officer.
“We were really left with no choice but to force the issue,” Estes
said.
UnitedHealthcare
said Mount Sinai’s proposals would increase its rates by 43% to 58% over three
to four years. “We continue to await a realistic proposal from Mount Sinai
that’s affordable and sustainable for New Yorkers and employers,” the company
said.
Estes
called the insurer’s description of Mount Sinai’s rates inaccurate, but he
wouldn’t say what the hospital system was requesting.
New
Yorker Beth Balsam and her two daughters are now racing to see Mount Sinai
doctors. Balam’s daughters squeezed in appointments this week. She booked an
appointment next week.
“We’re trying to get our healthcare as up to date as possible,
recognizing, like, we may be in the desert for a while,” she said. “Or a long
while.”
Patients
have limited protections under federal and state rules. Sometimes insurers keep
paying for medical services during a contract dispute to avoid running afoul of
regulations requiring adequate doctors and other services.
Federal
protections against surprise medical bills also give patients temporary
additional coverage for ongoing treatment for serious or complex conditions,
pregnancy, or who are already hospitalized.
State
regulations, meanwhile, can help some people keep coverage for ongoing
treatment for a period of time.
In New
York, people can get 60- to 90-day extensions in some circumstances, but only
if their employer is one that purchases a health plan for its workers, rather
than a so-called self-insured employer that finances coverage itself.
A.J.
Palumbo and May Chan, of Suffolk County, N.Y., are scrambling to see whether
UnitedHealthcare will cover Chan’s C-section at a Mount Sinai hospital
scheduled for March 6, five days after the insurer has said it will stop
coverage at the hospital.
Palumbo,
40, and Chan, 38, want to go ahead with the C-section at the hospital. They
hadn’t budgeted for paying for delivery without insurance, said Palumbo, who
fears it could cost them tens of thousands of dollars.
He is
waiting anxiously for written confirmation that UnitedHealthcare will cover the
delivery. “I tend to be as careful as I can be,” he said.
Source: Wall Street Journal