Frequently Asked Questions

United allowed Montefiore’s contract to expire. As of January 1, 2021 Montefiore Health System is no longer in 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 deeply disappointed in United’s decision to turn its back on our community and block in-network access to more than 60,000 patients.

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. We’ve done everything in our power to get United to return to the table, including offering several paths forward that would have immediately restored access, but United has stopped negotiating and signaled their decision is permanent.

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 protections for patients, 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. Unlike United, Montefiore has offered multiple paths forward to immediately restore in-network access based on previously mutually-agreed upon contract terms and would also include a safety net that would protect from this situation repeating by removing an expiration date on our contract. Yet despite our best efforts, United has continued to reject our offer and has stopped negotiating. Unfortunately, based on United’s repeated behavior, it appears the insurer has turned its back on our community permenantly.

COMMERCIAL: UnitedHealthcare, Oxford, UMR, Compass (Exchange)
The contract with United/Oxford that covers the care we deliver to commercial patients expired on December 31, 2020. As a result, all  Montefiore Health System physicians are out of network with United as of January 1, 2021.  On March 1, 2021, all hospital services out of network for all United commercial patients as well.  

MEDICAID: UnitedHealthcare Community Plan Medicaid (Including CHP, Essential Plans, HARP)
The contract with United that covers the care we deliver to Medicaid patients expired on December 31, 2020. As a result,  all Montefiore Health System physicians are out of network with on January 1, 2021 and hospital services out of network on March 1, 2021.

DUAL MEDICARE: UnitedHealthcare Community Plan Dual Advantage (D-SNP)
United allowed the contract that covers the HOSPITAL and DOCTOR care we deliver to UnitedHealthcare Dual Advantage (also referred to as Dual Special Needs Plan DSNP) to expire at midnight on March 31, 2021.

Health plans affected by the negotiations, 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 (#4 in product name below)
  • UnitedHealthcare Community Plan Medicaid (#1-#3 in product name below)

While it is not our decision, United has stopped negotiating. The paths forward Montefiore has presented to United, that have been based on previously agreed-upon contract terms, have been rejected flat out. It is clear United has made the decision to permanently block in-network access to Montefiore. While we cannot force United to join us in working in the best interest of our patients and community, we will always be there for our patients and help them understand every option available to restore the access to their doctors and hospitals they deserve.

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

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

Many local companies – of all sizes – have switched plans or offered second plans to help their employees regain in-network access to their trusted doctors and hospitals. 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 indicated they plan to permenantly block your in-network access to Montefiore, 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 at:  KeepMontefiore.Org.

No, as a courtesy to our patients,  we will continue to bill United/Oxford for services provided to their 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.

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 todayto request a Continuity of Care Form and apply. If you believe you are eligible for Continuity of Care but United denies you, or if United prematurely cuts off your Continuity of Care, contact your physician.  

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 after January 1, 2021.

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.

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 visit www.KeepMontefiore.org often for the latest information or contact us on our patient information line at (855) 226-3071.

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

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.

Now that Montefiore is out of network with United, 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 Community Plan Medicaid

Medicaid Patients: All Montefiore Health System physicians are out of network effective January 1, 2021 and Montefiore hospitals are out of network effective March 1, 2021.  

Medicaid patients with UnitedHealthcare Community plans no longer have in-network access to Montefiore doctors as of January 1, 2021 and Montefiore hospitals as of March 1, 2021.

To keep your Montefiore doctor(s) and hospitals, you can 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 visiting nystateofhealth.ny.gov to choose a different plan.

All Montefiore Health System doctors are out of network beginning on January 1, 2021. Montefiore hospitals are out of network beginning on March 1, 2021.

Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date, may qualify for Continuity of Care through United that would extend your in-network benefits. 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.

 

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.

Change your Medicaid plan.

You can 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 visiting nystateofhealth.ny.gov to choose a different plan.

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

EmpireBCBS HealthPlus*
800-300-8181
https://mss.empireblue.com/
**Excluding White Plains Hospital and Physicians**

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

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

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

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

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

Apply for Continuity of Care.

Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date, may qualify for Continuity of Care through United that would extend your in-network benefits. 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.

 

UnitedHealthcare Community Plan Dual Advantage (UnitedHealthcare Dual Advantage) – Medicare (Medicare DSNP, sometimes called Dual Eligible, Dual Special Needs)

Medicare Dual Eligible Patients:

As of April 1, 2021, all Montefiore hospitals and doctors out of network for patients with UnitedHealthcare Community Plan Dual Advantage.

Despite our best efforts, United has stopped negotiating and now Montefiore hospitals and doctors out of network for Medicare Dual Eligible (DSNP) patients with UnitedHealthcare NY Dual Advantage effective April 1, 2021.

United is the only insurer who is blocking in-network access to Montefiore. The fastest way to regain in-network access to their trusted doctors and hospitals is to switch to one of the many other insurance plans that partner with Montefiore.

Certain patients, including those who are hospitalizedor undergoing an active course of treatment prior to the contract end date, may qualify for Continuity of Care through United that would extend your in-network benefits. 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.

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.

UnitedHealthcare Community Plan – NY Dual Advantage Medicare Dual Eligible Patients:

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 Medicare Advantage Open Enrollment:

  • 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
877-237-1303
https://healthfirst.org

WellCare – 3.5 STARS
866-237-1303
https://www.wellcare.com/en/New-York

Aetna Medicare Assure – 4 STARS
718-354-6078
https://www.aetnamedicare.com/

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
877-411-3625
https://www.emblemhealth.com/Our-Plans/

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

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.

**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 now, no data. 
800-343-3547
https://riverspringmap.org/

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

UnitedHealthcare Commercial and UnitedHealthcare Oxford (Gets coverage through their employer) or UnitedHealthcare Compass (Individual Exchange)

Now that United has let our contract expire, patients with UnitedHealthcare, UnitedHealthcare Oxford, UMR, or Compass commercial plans no longer have in-network access to our hospitals and physicians as a result of United forcing our hospitals and physicians out of network on January 1, 2021.  United patients may have to pay more in out-of-pocket costs to visit Montefiore Health System hospitals and physicians out of network. We are disappointed with United’s decision, but remain committed to doing everything in our power to restore our in-network status with United as soon as possible through a fair contract that allows us to continue to provide the quality care you rely on.

Because United stopped negotiating,  all Montefiore hospital services are out of network effective March 1, 2021 for all United commercial patients.

All Montefiore Health System physicians (effective January 1, 2021) and hospital services are out of network effective March 1, 2021 for all Commercial patients. We understand that some patients may have had appointments scheduled on or after March 1, 2021. If you choose to keep your appointment, United may subject you to paying higher out-of-pocket costs.

Certain patients (regardless of coverage type), including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date, may qualify for Continuity of Care through United that would extend your in-network benefits. If you think you may qualify, you should call the Member Services phone number on the back of your United health insurance card today to request a Continuity of Care Form and apply. If you believe you are eligible for Continuity of Care but United denies you, or if United prematurely cuts off your Continuity of Care, contact your physician.  

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.

(Commercially insured through employer) Speak with your HR manager today.

  • Many companies have switched insurance plans or offered second options as a result of United’s actions and in order to allow their employees to regain in-network access to the trusted doctors and hospitals they need. As United has made it clear their decision is permenant, now’s the time to speak with your HR department. Even if you think you cannot switch, you may have more options than you think. Contact your HR department and let them know the importance of keeping your in-network access to your Montefiore Health System hospital and providers. As them about your options to protect your access, including offering a second coverage option that will help you continue to receive the care from your Montefiore physicians that you need.
  • Please find a letter template you can use to send to your HR department here

(Compass Individual Exchange Patients) Consider changing health plans.

  • You will have the opportunity to switch to an insurance company that will guarantee your in-network access to your Montefiore doctors and hospitals for the full 2021 benefit year. The new open enrollment period runs until August 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 United health insurance card to see if you qualify. If you believe you are eligible for Continuity of Care but United denies you, or if United prematurely cuts off your Continuity of Care, contact your physician.


Call United today.

  • Tell Andrew Witty, CEO, UnitedHealthcare that you deserve more from your insurance company.  Call Sir Witty at (952) 205-7401.

Montefiore continues to accept all other major insurance plans in the New York metropolitan area, and most small regional plans, many of which we have multi-year agreements with. Most recently, EmpireBCBS recently renewed their partnership with Montefiore for multiple years. Visit www.montefiore.org/insurance-plans-accepted to see all insurance plans with which we participate. Specifically, we are a participating provider with:

  • EmpireBCBS
  • Cigna
  • Aetna
  • EmblemHealth
  • HealthFirst
  • MVP
  • Oscar