United Healthcare and Hospitals Miss Out-of-Network Deadline

Medical insurance carrier United Healthcare and the East End Health Alliance, a consortium that includes , and , failed to reach a new agreement before their contract expired on Thursday, and now 3,000 East End residents will find their insurance is not accepted at all or they will have to pay out-of-network rates to continue to use the hospitals.

The 3,000 affected belong to self-insured plans that United Healthcare acts as the third-party administrator to, such as the East End Health Plan, in which many school districts participate. On Sept. 15, an additional 12,000 residents who subscribe to United Healthcare or its subsidiary Oxford will be in the same boat. The extra time is mandated by New York State, which requires a 60-day “cooling off period” after the deadline, during which the contract is expired but policyholders will still be considered in-network.

East End Health Alliance spokesman Paul Connor  that the disparity between the dates health care customers will be affected by the contract expiration is a result of different state regulations for different types of insurance plans.

Connor said at the time that talks had been productive, but he expected, as is typically the case in these negotiations, that it would come down to the wire. The health alliance and United Healthcare are negotiating over how much money the insurance company will reimburse the hospitals for visits, procedures, tests, surgeries and other care and costs.

"The current level of reimbursement from United Healthcare/Oxford and the proposed increases are inadequate to sustain our quality goals," the East End Health Alliance stated on its website. "We owe it to the communities that rely on us to be the best we can. Ultimately, it is the patients' interests we are trying to preserve."

Emergency care continues to be covered at in-network rates. Continuing care, such as pre-natal care, will also be covered.

Doctors are being advised to refer their patients to in-network facilities: in East Patchogue, John T. Mather Memorial Hospital in Port Jefferson, Saint Charles Hospital in Port Jefferson, Stony Brook University Medical Center, St. Catherine of Siena Medical Center in Smithtown, and Southside Hospital in Bay Shore.