Sarah Feldman, 35, received the first ominous letters from Mount Sinai Medical last November. The New York hospital system warned it was having trouble negotiating a pricing agreement with UnitedHealthcare, which includes Oxford Health Plans, Feldman’s insurer.
“We are working in good faith with Oxford to reach a new fair agreement,” the letter said, continuing reassuringly: “Your physicians will remain in-network and you should keep appointments with your providers.”
Over the next few months, a flurry of communications about the dispute from both the hospital and the insurance company arrived. “It was, ‘You have to worry, you don’t have to worry,’” Feldman told me.
In late February, the other shoe finally dropped. As of March 1, Mount Sinai would no longer be in-network with Feldman’s insurer.
“I suddenly have to change all my doctors — here’s some stress for you,” Feldman said. That included not only a beloved primary care physician but also a gynecologist, an orthopedist, and a physical therapist.
One of the most unfair aspects of medical insurance, in a system that often seems designed for frustration, is this: Patients can change insurance only during end-of-year enrollment periods or at the time of “qualifying life events,” such as a divorce or job change. But insurers’ contracts with doctors, hospitals and pharmaceutical companies (or their arbiters, so-called pharmacy benefit managers) can change abruptly at any time.
That is particularly galling for patients because, whether obtaining insurance through an employer or buying it on the marketplace, they generally choose a policy based on whether it covers their desired doctors and hospital or an expensive drug they need. Turns out that particular coverage could evaporate at any time during the policy term.
Consumers are put at risk, according to a recent report by the Robert Wood Johnson Foundation, in the escalating warfare over pricing between big, consolidated hospital systems and ever-bigger insurers in a cutthroat market. Such contract disputes are increasing rapidly — the Becker’s Hospital Review website cites 21 insurer-provider standoffs in the third quarter of 2023, a 91% increase over the same period the year before.
For example, last September, the physicians at Baptist Health in Kentucky abruptly cut ties with patients enrolled in Humana’s Medicare Advantage plans, and physicians at Tennessee’s Vanderbilt Health broke off contracting with a number of Humana Plans in April — in both cases sending patients scrambling to find new in-network doctors affiliated with other hospital systems. And experts predict more contract terminations in a merciless market. (That includes more Jan. 1 terminations each year — but in that case, at least, the patients cast adrift have the ability to shop for a new plan that covers their doctors and drugs.)