Times Headlines Insurer’s Battle with LICH, other Hospitals

The contract dispute between UnitedHealthcare, the health insurance giant that controls the popular Oxford Health Plans, and Continuum Health Partners, the hospital consortium that controls Long Island College Hospital, is the subject of a front page article in today’s Times:

The New York Times: A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.

The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare, which includes Oxford health plans and has 25 million members across the country, one million of them in New York.

Principal sticking points in the dispute are Continuum’s demands for increased payments, and United’s insistence that hospitals notify insurers within 24 hours of any patient admission or face a penalty of having reimbursement for that patient’s treatment cut in half.

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  • AEB

    As a holder of Oxford coverage, which is an United Heathcare “product,” I received a letter yesterday informing me that as of last Jan 1, their contract with Continuum is “terminated.”

    Thus, as of March 1, I will no longer be covered at Continuum hospitals, including, of course, LICH.

    So, unfortunately, the deed appears to be done.

  • frbullwalker

    I too have Oxford coverage and their premiums went up an average of 20% this year for all NYC policy holders-
    ours went up 25% and we have not filed a claim over the past year.

  • http://selfabsorbedboomer.blogspot.com Claude Scales

    The parties are still in negotiation, so the deed isn’t done until the March 1 deadline (the state requires a two month “grace period” from the date the contract expires) comes and there’s still no agreement.

  • AEB

    So, Claude, the letter I received represents a kind of “it’s a done deal unless you hear otherwise but we don’t want you to think in those terms”?

  • EAC

    I am also with Oxford and received this letter yesterday. Sounded like a done deal to me.

  • http://selfabsorbedboomer.blogspot.com Claude Scales

    We got the same letter. It’s still not a done deal until the grace period ends (or is extended by regulatory or judicial intervention, which could happen) and there’s no agreement. Continuum and United are talking, and the dispute could yet be resolved.

  • Teddy

    So what happens to people with Oxford coverage if there’s an emergency (cardiac arrest for example) and LICH is the closest hospital, which for us it is?

    The majority of people I know are with Oxford.

  • othersideofthebridge

    Teddy, if your plan allows for out of network coverage, then you will have to pay your deductible for the visit (e.g., $5000 for the year) then Oxford will cover 70% of the remaining cost and you are responsible for the other 30%. These figures are just examples; it would depend on your plan. If you have only In-network coverage, you’re just screwed. You just have to hope that the EMT checks your insurance and directs the driver to a hospital that takes it and hope that hospital isn’t far enough away to end up killing you.

  • north heights res

    I believe that the letter explicitly states that emergency visits will still be covered at any hospital. I received the letter, too, but don’t have it here. Can anyone verify that?

  • othersideofthebridge

    I just spoke with my doctor, who is a specialist at Beth Israel, and the secretary said that Continuum went to court and got an injunction and will be to see patients indefinitely past the original March 1st cutoff.

  • Joann

    I have United Health Care through my employer, but it is not Oxford. The letters I received, both from both Beth Israel and UHC, sstated that emergency procedures will be covered.