‘They’re Freaking Out:’ Letters Warn Patients They Risk Losing Their Doctor
Patients are caught in the middle of contract disputes between hospitals and health insurers
Sarah Digby may lose coverage at the end of May.
By Melanie EvansFollow | Photographs by Sarah Blesener for The Wall Street Journal
Updated March 1, 2024 6:24 pm ETSAVESHARETEXT
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.
‘Look at how much pain and suffering you are causing,’ says Sarah Digby.
Digby sees doctors at NewYork-Presbyterian, which said in the email she may lose her insurance coverage from CVS Health’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.
NewYork-Presbyterian is sparring with CVS Health’s Aetna. PHOTO: GABRIELA BHASKAR FOR THE WALL STREET JOURNAL
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 UnitedHealth Group, 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.
UnitedHealthcare ended coverage for some Mount Sinai hospitals as of Friday.
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.
Beth Balsam with her daughter Ilana Klein. They are racing to see Mount Sinai doctors.
“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.
Write to Melanie Evans at melanie.evans@wsj.com
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