“Patients should not be forgotten in contract negotiations between healthcare providers. They should be front and center.”
Adi Talwar
A huge number of medical patients in New York City now face the terrifying possibility of losing their in-network health insurance. United Healthcare (UHC), the nation’s largest health insurance company, and Mount Sinai Health System, New York City’s second largest hospital system, will keep Mount Sinai’s hospital within the insurer’s network We are in a dispute over the renewal of the contract.
If UHC and Mt. Sinai’s entire hospital system network may be lost. As of January 1, several of Mount Sinai’s hospitals have already been designated out-of-network by UHC due to ongoing issues. If no agreement is reached by March 22, all Mount Sinai hospitals and physicians will be removed from UHC’s network of insured patients.
Where do patients fit into this debate? Medical uncertainty is a byproduct of contract negotiations, and they are left behind. As the March deadline approaches, I urge both parties to find a solution that will protect patients from the real harm caused by this corporate disagreement. Patients must not be forgotten in contract negotiations between medical institutions. They should be the focus.
When considering the most vulnerable victims of such medical business disputes, it is important to consider patients with chronic conditions such as Crohn’s disease and inflammatory bowel disease (IBD), including ulcerative colitis. Approximately 1 in 100 Americans suffer from these diseases, which require lifelong care and professional health care providers. Finding the right gastroenterologist often takes years of consultations. Renowned academic medical centers like Mount Sinai offer expert teams of physicians experienced in researching and treating complex conditions not available at other medical facilities.
It can be frightening for patients to find out that their favorite doctor is suddenly no longer covered by their insurance. Established treatment plans may be altered or discontinued, jeopardizing progress toward remission and potentially causing dangerous health complications. For people with IBD, stress can contribute to disease flare-ups, exacerbating suffering during an already stressful time.
As CEO of the Crohn’s and Colitis Foundation, I often hear stories of fear and anxiety from people with IBD about the potential for disruption to their access to care. Recently, a 29-year-old Crohn’s disease patient at Oxford Health Plans, a subsidiary of United Healthcare, contacted me with concerns about not being able to contact her primary care physician, a renowned gastroenterologist at Mt. Sinai. He confided in me.
This doctor is an integral part of her trusted care team, which took years to establish. This patient was diagnosed at the age of 13 and has a complex medical history spanning 16 years. She said: “When you have a chronic illness, it’s very difficult to find a doctor that you really trust and who understands your life, and it takes time to establish that. It takes years to build a relationship and trust. I am very sad and frustrated that I may have to part ways with my gastroenterologist and surgeon.”
This patient’s experience illustrates the tremendous strain placed on those forced to transition to a new health care provider, and her story is not unique. Many times, patients end up stuck in an out-of-network situation as insurance companies and hospitals fight over contracts. Such conflicts have only increased since the COVID-19 pandemic. For parents of pediatric patients, this predicament can be especially difficult. This is because pediatric experts with expertise in diseases like IBD are difficult to find.
UHC and Mount Sinai have the power to alleviate the situation for these patients by reaching an agreement that guarantees continued in-network access. People with chronic illnesses don’t have to fight to get the things they need to stay healthy, like regular doctor visits, medications, and treatments.
A patient I spoke to said: “Really, the uncertainty was the worst part.” While traveling abroad on his honeymoon, the patient called both Oxford and Mount Sinai, but “everybody was equally confused and on March 1 I have not received a clear answer as to whether my doctor or surgery will be covered after that date.” For patients with chronic intractable diseases like IBD, such uncertainty not only puts a physical and mental burden on them, but it also puts a financial burden on them as they wait to see if their treatment will remain in their insurance company’s network. It is also physically taxing.
Our nation and city need a patient-centered approach to healthcare contract negotiations. I am looking forward to the agreement between UHC and Mount Sinai, similar to what UHC has previously entered into with major health care providers, to alleviate the uncertainty facing hundreds of thousands of patients in New York City. We hope that a swift agreement can be reached. UHC and Mount Sinai must now listen to the voices of those they serve, find empathy, and come together to provide a continuum of care that supports individuals on their path to healing. A patient-centered approach to this and other similar debates is the only way forward.
Michael Osso is the President and CEO of the Crohn’s and Colitis Foundation.