United Healthcare, Memorial Sloan Kettering set to take contract squabbles to mediation
The clock is ticking on United Healthcare and Memorial Sloan Kettering Cancer Center to reach a contract agreement or thousands of patients could lose coverage for much-needed care.
CBS News New York spoke with one impacted woman who said it's a matter of life and death for many.
Deadlines to be aware of going forward
The current contract is in effect through June 30. If no deal is reached, Memorial Sloan Kettering says it will become out of network for most patients with United Healthcare or Oxford plans. However, New York has a 60-day "cooling off" rule, meaning those with fully insured plans would still have in-network access to MSK hospitals through Aug. 30.
That, however, does not apply to physician services and ASO plans, also known as self-funded.
As for patients in the middle of treatment, a United Healthcare spokesperson said they may qualify for "continuity of care," which provides continued in-network benefits for a specified period of time.
When asked how many patients stand to be impacted if a contract agreement isn't reached, Tracy Gosselin, a senior vice president and chief nurse executive at Memorial Sloan Kettering, said, "We have a little over 19,000 patients currently covered under the contract."
Gosselin went on to say, "Cancer is a very expensive disease to battle. You can still be fully covered, but out of pocket expenses could be travel to and from sites, could be different things related to care for your children, and they do add up."
"We will remain at the negotiating table as long as it takes"
United Healthcare released the following statement on the contract talks with Memorial Sloan Kettering.
"Our top priority is to reach an agreement with MSK that is affordable for consumers and employers. We have proposed meaningful rate increases that would continue to reimburse MSK at levels significantly higher than other National Cancer Institute-designated health systems in the New York City metro area," a spokesperson said, adding, "Unfortunately, MSK has refused to move off its demands for a 35% price hike that would increase health care costs by $469 million and directly impact self-insured employers. We will remain at the negotiating table as long as it takes to renew our relationship with MSK. We hope they join us there and provide a proposal people and employers can afford."
Memorial Sloan Kettering told CBS News New York that United Healthcare has kept rate increases for hospital services at just 1.6% per year over the past five years, far below inflation and rising costs of care.
Memorial Sloan Kettering also said it has taken extensive measures to reduce costs in recent years, including reducing staff. However, it says rising costs continue to outpace United Healthcare's reimbursements and MSK cannot continue to absorb the increases without a sustainable contract.
United Healthcare and Memorial Sloan Kettering provided updates on their websites. Please click here and here. Both are encouraging patients to use their services to help navigate the situation. CBS News New York was told mediation is happening on Friday. Both parties have expressed the priority is to reach an agreement.
United Healthcare says people enrolled in the Empire Plan are not impacted.
"Not having that access to MSK is very scary"
As a mother, Sheila Kolt's dream is to watch her children grow up.
"Sadly, I do have the BRCA gene. My whole family has had different types of cancer and passed away from cancer," Kolt said.
Those risk factors led the 45-year-old to make the difficult decision to have preventative surgeries, including a bilateral mastectomy at Memorial Sloan Kettering, last year.
"Thank goodness I did that because when they biopsied the breast tissue after the fact, they found precancerous cells," said Kolt, who now requires monitoring.
She recently received a letter from United Healthcare regarding ongoing contract negotiations with Memorial Sloan Kettering, which reads, in part, "If we're unable to reach an agreement, Memorial Sloan Kettering Cancer Center may no longer be part of your health insurance's network beginning July 1, 2025."
"It made me feel incredibly sad because MSK saved my life," Kolt said. "That means no coverage at all. I have to find new doctors. I see those bills and I say oh my God, thank God I have health insurance. It's tens of thousands of dollars."
Kolt said she just hopes her journey remains at Memorial Sloan Kettering and cancer free.
"Not having that access to MSK is very scary. It's very scary," she said.
Kolt has also been working on a documentary to share her story and encourage other women to get genetic testing.
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