Frequently Asked Questions

United allowed Montefiore’s contract to expire. As of January 1, 2021, Montefiore Health System has been dropped from United’s network. This includes commercial insurance products under the branding UnitedHealthcare and UnitedHealthcare Oxford, UMR, Compass Exchange plans, UnitedHealthcare Community Plan Medicaid (all products), and UnitedHealthcare Community Plan Medicare Dual Advantage (Medicare and Medicaid eligible). United’s decision impacts patients in-network access at Montefiore Medical Center, Montefiore Mount Vernon, Montefiore New Rochelle, Montefiore Nyack, Montefiore St. Luke’s Cornwall Hospital and White Plains Hospital and all of our employed providers. United may subject these patients to higher out-of-pocket costs when they receive care with their Montefiore hospital and doctors. We are disappointed by United’s decision to block in-network access to 60,000 patients but are committed to doing everything in our power to urge United to restore access.

Montefiore’s focus has always been and continues to be achieving a fair contract that supports our mission to provide high-quality care to all patients regardless of their ability to pay. Despite our very best efforts to reach a reasonable agreement, United made the decision to force Montefiore out of network during a global pandemic. Nevertheless, Montefiore will continue to work in good faith to urge United to work with us to restore much needed in-network access to the 60,000 impacted patients.

We will continue to fight to restore in-network access to the care you know and trust, but no one can predict how long that may take. While United has finally returned to the negotiating table, there is still a significant gap between what United is demanding and a fair and sustainable agreement. Montefiore has offered a good faith extension that would bring Montefiore back in network effective immediately through May 31, 2021 and absent a new agreement would automatically ensure continued long term access at the same terms as United’s previous agreed to contract in 2018.

  • I have insurance through my employer.
    The contract with United/Oxford that covers the care we deliver to commercial patients expired on December 31, 2020.
  • I have a Compass individual exchange plan.
    The contract with United that covers the care we deliver to individual exchange patients expired on December 31, 2020.
  • I have Medicaid.
    The contract with United that covers the care we deliver to Medicaid patients expired on December 31, 2020, but by law United must treat Montefiore hospitals as in-network until midnight on March 1, 2021.
  • I have Medicare DSNP.
    The current contract with United that covers the care we deliver to Medicare Dual Eligible (DSNP) patients is still effective. However, unless United is willing to work with us in good faith to reach a fair contract, our contract will expire on March 31, 2021.

Health plans affected, include:

  • UnitedHealthcare Commercial and UMR (employer-sponsored plans)
  • UnitedHealthcare Oxford Commercial (employer-sponsored plans)
  • UnitedHealthcare Compass Exchange plans (individual)
  • UnitedHealthcare Community Plan Dual Advantage – dual eligible special needs plan – where a patient has both Medicare and Medicaid
  • UnitedHealthcare Community Plan Medicaid

Even if your employer currently only offers a United/Oxford/UMR health plan, they still need to hear from you. Your employer may have the option, perhaps through their broker, to offer a second option and special open enrollment period in light of these extraordinary circumstances. Now that United has forced Montefiore out of network, let your employer know that you need to continue to be able to see your trusted Montefiore doctors and hospitals. Many patients have requested a template to use to reach out to their HR/Benefits Manager. You can find a downloadable template here.

Know that in the meantime, Montefiore remains open to engaging productive discussions with United that allow us to reach an agreement that makes this right. We encourage you to also contact United and let them know the frustration their actions have unfairly caused you.

The following Montefiore Health System hospitals and their employed physicians are impacted:

  • Montefiore Medical Center
  • Montefiore Mount Vernon
  • Montefiore New Rochelle
  • Montefiore Nyack
  • Montefiore St. Luke’s Cornwall Hospital
  • White Plains Hospital

Commercial Patients
United has forced all Montefiore Health System physicians out of network effective January 1, 2021.
Some United commercial patients (fully insured, most Oxford and Compass patients) may be eligible for covered HOSPITAL services only on an in-network basis for an additional 60 days until midnight March 1, 2021. Please call the Member Services number on the back of your Member ID card today to find out if you are eligible for this extension.

Individual Exchange Patients
United has forced all Montefiore Health System physicians out of network effective January 1, 2021.
You will still have in-network access to our HOSPITALS ONLY through March 1, 2021.

United has forced all Montefiore Health System doctors out of network as of January 1, 2021. UnitedHealthcare Community Plan Medicaid patients will receive in-network access to Montefiore HOSPITAL services only until midnight March 1, 2021.

Patients with United Medicare DSNP Community Plans will still have in-network access to our hospitals and doctors through March 31, 2021. Your in-network access will only change if United is unwilling to reach an agreement before our contract expires. If that happens, United will force our hospitals and doctors out of network on April 1, 2021.

Even if your doctor is not employed by Montefiore, United may still subject you to higher out of pocket costs for any care received at a Montefiore hospital on or after January 1, 2021.

I get my insurance through my employer.
Now that United has ended our contract, you may be subject to paying higher out-of-pocket costs from United for appointments scheduled on or after January 1, 2021.

 

I have an individual exchange plan.
Now that United has ended our contract, you may be subject to paying higher out-of-pocket costs from Compass for appointments scheduled on or after January 1, 2021.

 

I have a Medicaid plan.
United has ended our contract, dropping your in-network access to all Montefiore Health System doctors beginning on January 1, 2021. You will have in-network access to your Montefiore HOSPITAL ONLY until March 1, 2021. Now that United has ended our contract, United may charge you more for appointments.

 

I have a Medicare DSNP plan.
We understand that some patients may have appointments scheduled on or after April 1, 2021. If this is the case, you should call your doctor’s office to request that the appointment or procedure be rescheduled prior to that date, if possible. If you are unable to reschedule your appointment or choose to keep your appointment, United may be subject to paying higher out-of-pocket costs.

Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to our contract ending, may qualify for Continuity of Care through United. If you think you may qualify, you should call the phone number on the back of your United health insurance card today to request a Continuity of Care form and apply.

Patients will always have in-network access to our emergency rooms, regardless of our contract status with United. If you experience an emergency, you should always visit the nearest emergency room. Patients needing emergency care are entitled to receive in-network treatment until the patient is stable. Once the patient is stable, you have a choice to either continue care with Montefiore Health System at the higher out-of-pocket cost or be transferred to a hospital that is in network with your health insurance plan.

If you are already admitted to the hospital prior to our contract expiring, you will be covered at in-network rates through the end of your inpatient stay.

For us, patients are always our central focus. We have been here, in our communities doing everything we can to keep you healthy, working, and with your loved ones. After months of delays and failure to negotiate in good faith, in the final hours of December 31, 2020 — without any intent to reach anagreement—United asked for an extension without an offer of progress nor incentive to move negotiations forward, further pressuring Montefiore to accept a deal that would have left patients with no guaranteed long-term in network access and jeopardizing the future of Montefiore’s ability to deliver critical services to our patients and communities.

Instead, Montefiore has offered United an extension that offers actual long term guaranteed in network access for patients, based upon terms we most recently had from our last contract. The extension would allow for immediate access to Montefiore hospitals and physicians and last until May 31, 2021.

If United is ultimately unwilling to reach an agreement with Montefiore to provide what is needed to care for our patients before May 31, 2021, our proposed extension would ensure continued access long term at the same terms as United’s previous agreed to contract in 2018. Unlike the prior extension that United offered Montefiore, this extension provides a good faith effort to restore access immediately to Montefiore physicians and hospitals for New Yorkers. Montefiore has also asked United to remove an expiration date from the agreement to prevent this type of disruption from happening again. It’s up to United to either provide different, sustainable terms or agree to this path forward.

That is not true. Unfortunately, this is one of United’s many falsehoods. Montefiore, a non-profit organization, isn’t responsible for a multi-billion-dollar corporation’s premiums.. In fact, United has requested high single to double digit premium hikes for their Oxford small group members year after year over the last several years – well before these negotiations began.

Montefiore has only asked for reasonable single digit annual increases that are in line with what other insurer’s pay. United has openly shared they are trying strengthen their market share. It is our responsibility to care for patients, all patients – not to help United or any insurance company make profits with your health care premiums.

The original extension that United offered included zero protections for patients from repeated disruption of care and clearly placed profits over patient care by handcuffing Montefiore financially for another 5 months while we continue to sustain economic losses. Had United’s extension offered such protections, Montefiore would have been able to accept it. From the beginning, Montefiore has been driven by our mission to sustainably care for all patients who rely on us. Montefiore has offered United an extension that offers actual long term guaranteed in network access for patients, based upon terms we most recently had from our last contract. The extension would allow for immediate access to Montefiore hospitals and physicians and last until May 31, 2021.

If United is ultimately unwilling to reach an agreement with Montefiore to provide what is needed to care for our patients before May 31, 2021, our proposed extension would ensure continued access long term at the same terms as United’s previous agreed to contract in 2018. Unlike the prior extension that United offered Montefiore, this extension provides a good faith effort to restore access to Montefiore physicians and hospitals for New Yorkers. Montefiore has also asked United to remove an expiration date from the agreement to prevent this type of disruption from happening again. It’s up to United to say yes.

What can I do to ensure I have continued in-network access to Montefiore Health System hospitals and services?

Speak with your HR manager today.
If you have an employer sponsored insurance plan, contact your HR department and let them know the importance of keeping your in-network access to your Montefiore Health System hospital and providers. Ask them about your options to protect your access, including a second coverage option. 

Even if your employer currently only offers a United/Oxford/UMR health plan, they still need to hear from you. Your employer may have the option, perhaps through their broker, to offer a second option and special open enrollment period in light of these extraordinary circumstances. Now that United has forced Montefiore out of network, let your employer now that you need to continue to be able to see your trusted Montefiore doctors and hospitals. Many patients have requested a template to use to reach out to their HR/Benefits Manager. You can find a downloadable template here.

Apply for Continuity of Care.
If you or a family member is pregnant or undergoing treatment for a chronic condition, you may qualify for Continuity of Care benefits. Call the customer service number on the back of your United health insurance card today to see if you qualify.

Call United today.
Let Sir Andrew Witty, CEO, UnitedHealth Group, know what it means to you to lose in-network coverage from Montefiore Health System. You shouldn’t have to choose between continuing your care with your trusted Montefiore providers at higher out-of-network costs or finding a new provider. Call Sir Witty at (952) 205-7401.

  • Ask him to commit to talk to Montefiore and work this out.
  • Ask him if United will commit to paying for your care directly instead of sending you the check and sticking you in the middle of this.

Consider changing plans.
You may have the opportunity to switch to an insurance company that will guarantee your in-network access to your Montefiore physicians and hospitals for the full 2021 benefit year. The new open enrollment period runs from February 15, 2021 until May 15, 2021. Switch by visiting https://nystateofhealth.ny.gov/.

We participate with the following individual exchange plans:

  • Empire BCBS HealthPlus
  • HealthFirst
  • Emblem
  • MVP
  • Oscar

Apply for Continuity of Care.
If you or a family member is pregnant or undergoing treatment for a chronic condition, you may qualify for Continuity of Care benefits. Call the customer service number on the back of your Compass health insurance card to see if you qualify.

Call United today.
Let Sir Andrew Witty, CEO, UnitedHealth Group, know what it means to you to lose in-network coverage from Montefiore Health System. You shouldn’t have to choose between continuing your care with your trusted Montefiore providers at higher out-of-network costs or finding a new provider. Call Sir Witty at (952) 205-7401.

  • Ask him to commit to talk to Montefiore and work this out.
  • Ask him if United will commit to paying for your care directly instead of sending you the check and sticking you in the middle of this.

Consider changing plans.
You may ask to change your managed United Medicaid plan any time if you have been enrolled for at least 12 months, or within the first 90 days of signing up. To keep your Montefiore doctor(s) and hospitals, you can change to a different health plan by calling 1-855-355-5777 or by visiting nystateofhealth.ny.gov. We are in network with the following plans for the full 2021 year:

HealthFirst Medicaid
877-237-1303
https://healthfirst.org/health-insurance/medicaid/

MVP Health Care
800-825-5687
https://www.mvphealthcare.com
/members/medicaid/

Affinity Health Plan
866-731-8001
https://www.affinityplan.org/

EmpireBCBS HealthPlus*
*(except White Plains Hospital)
800-300-8181
https://mss.empireblue.com/

Fidelis Care
800- 343-3547
https://www.fideliscare.org/

EmblemHealth Medicaid
877-411-3625
https://www.emblemhealth.com/Our-Plans/State-Sponsored-Programs

 

The best way to keep your Montefiore doctor(s) and hospitals is to change your health insurance plan by calling one of the insurance plans listed below.

You can make this change during the following Medicare Dual Open Enrollment periods:

  • January 1, 2021 – March 31, 2021 (A change you make during this time will go into effect the first day of the following month. For example, you make a change January 12th, your new plan would be effective February 1.)
  • April 1, 2021 – June 30, 2021 (A change you make during this time will go into effect the first day of the following month. For example, you make a change April 12th, your new plan would be effective May 1.)

Healthfirst – 4 STARS
844-488-1483
https://healthfirst.org/ 

WellCare – 3.5 STARS
866-527-0056
https://www.wellcare.com/en/New-York

FidelisCare – Plan is new – no data
800-343-3547
https://www.fideliscare.org

EmpireBCBS – 3 STARS
800-300-8181
https://mss.empireblue.com/

EmblemHealth – 3 STARS
800-859-4880
https://www.emblemhealth.com/Our-Plans/

ElderPlan – 3.5 STARS
888-499-4058
www.elderplan.org

Centers Plan for Healthy Living – 3.5 STARS
877-940-9330
https://www.centersplan.com/ 

**Below Plans are ONLY for Montefiore Medical Center Patients**

AgeWell New York – 2.5 STARS
866-237-3210
https://agewellnewyork.com/

RiverSpring / ElderServe – Plan is new – no data
800-362-2266
https://riverspringmap.org/

Hamaspik Choice – Plan is new – no data
855-552-4642
https://www.hamaspikchoice.org/

The Centers for Medicare & Medicaid Services provides star ratings to help patients compare the quality of plans. Health Plans may earn a maximum of 5 stars based on their Quality Performance.

Montefiore continues to accept all other major insurance plans in the New York metropolitan area, and most small regional plans. A full list of all health plans we participate with can be found at Montefiore.org/insurance-plans-accepted.

You may ask to change your United Medicaid plan any time if you have been enrolled for at least 12 months, or within the first 90 days of signing up. The easiest way to restore your in-network access to Montefiore doctor(s) and keep your in-network access to Montefiore hospitals is to change to a different health plan (list of accepted plans included on second page) by calling 855-355-5777 or visit nystateofhealth.ny.gov to choose a different plan.

Montefiore participates in the following Medicaid, CHPlus, and Essential Plan Health Plans:

 

HealthFirst Medicaid
877-237-1303
https://healthfirst.org/health-insurance/medicaid/

MVP Health Care
800-825-5687
https://www.mvphealthcare.com
/members/medicaid/

Affinity Health Plan
866-731-8001
https://www.affinityplan.org/

EmpireBCBS HealthPlus*
*(except White Plains Hospital and Physicians)

800-300-8181
https://mss.empireblue.com/

Fidelis Care
800- 343-3547
https://www.fideliscare.org/

EmblemHealth Medicaid
877-411-3625
https://www.emblemhealth.com/Our-Plans/State-Sponsored-Programs

The best way to keep your Montefiore doctor(s) and hospitals is to change your health insurance plan by calling one of the insurance plans listed below.

You can make this change during the following Medicare Dual Open Enrollment periods:

  • January 1, 2021 – March 31, 2021 (A change you make during this time will go into effect the first day of the following month. For example, you make a change January 12th, your new plan would be effective February 1.)
  • April 1, 2021 – June 30, 2021 (A change you make during this time will go into effect the first day of the following month. For example, you make a change April 12th, your new plan would be effective May 1.)

Healthfirst – 4 STARS
844-488-1483
https://healthfirst.org/ 

WellCare – 3.5 STARS
866-527-0056
https://www.wellcare.com/en/New-York

FidelisCare – Plan is new – no data
800-343-3547
https://www.fideliscare.org

EmpireBCBS – 3 STARS
800-300-8181
https://mss.empireblue.com/

EmblemHealth – 3 STARS
800-859-4880
https://www.emblemhealth.com/Our-Plans/

ElderPlan – 3.5 STARS
888-499-4058
www.elderplan.org

Centers Plan for Healthy Living – 3.5 STARS
877-940-9330
https://www.centersplan.com/ 

**Below Plans are ONLY for Montefiore Medical Center Patients residing in the Bronx**

AgeWell New York – 2.5 STARS
866-237-3210
https://agewellnewyork.com/

RiverSpring / ElderServe – Plan is new – no data
800-362-2266
https://riverspringmap.org/

Hamaspik Choice – Plan is new – no data
855-552-4642
https://www.hamaspikchoice.org/

The Centers for Medicare & Medicaid Services provides star ratings to help patients compare the quality of plans. Health Plans may earn a maximum of 5 stars based on their Quality Performance.

No, as a courtesy to our patients, even though United/Oxford has dropped us from its network, we will continue to bill United/Oxford for services provided to its members regardless of coverage type. We will bill you for any amounts you owe following receipt of the explanation of benefits and any payment from United/Oxford.

We have a very fair financial assistance program which may be able to help you manage your payments. Please contact your hospital’s financial department for more information:

  • Montefiore Medical Center, Montefiore Mount Vernon and Montefiore New Rochelle – call 718-920-5658
  • Montefiore Nyack Hospital – call 845-348-2323
  • Highland Medical, P.C – call 866-550-4672
  • Montefiore St. Luke’s Cornwall Hospital – call 845-458-4000
  • White Plains Hospital – call 914-681-1004

For the most up-to-date information, we encourage you to contact us on our patient information line at (855) 226-3071. You may also visit this website often for the latest information.

The New York State Health Insurance Plan (NYSHIP) also known as Empire Plan or the United Healthcare Blue Cross Employees Plan is NOT affected. Even though NYSHIP Empire Plan is run by UnitedHealthcare it has no affiliation with UnitedHealthcare insurance products.

Now that United has forced Montefiore out of network, you can contact United to understand your out-of-network coverage benefits and get an estimate of what United may require you to pay based on your specific benefits.

UnitedHealthcare AARP Medicare Supplement plans are NOT affected. Medicare Supplement is NOT a managed care insurance product. It is used to cover gaps in coverage for Traditional Fee-For-Service Medicare and can be used anywhere Medicare is accepted with no restrictions.