A trauma room at Mount Sinai South Nassau hospital in Oceanside.

A trauma room at Mount Sinai South Nassau hospital in Oceanside. Credit: Newsday/Jeffrey Basinger

Amid a payment rate dispute, Mount Sinai South Nassau hospital and five other Sinai facilities in the city have been bumped from the provider network for UnitedHealthcare, which could impact nearly 16,000 Long Islanders, the insurance company and health system said.

UnitedHealth members with employer-sponsored plans started to lose in-network benefits at the Oceanside hospital and Mount Sinai locations in the city on Jan. 1, according to UnitedHealthcare, which owns Oxford Health, a group that has traditionally served small and mid-size companies. Once mandated “cooling-off” periods pass, about 15,900 Long Islanders could be impacted, Mount Sinai said. UnitedHealthcare has a total of 600,000 commercial members on the Island, the insurer said.

Mount Sinai and UnitedHealthcare said they would like to resolve the impasse.

Self-insured plans — where employers assume the risk and pay for care — currently have in-network privileges at Mount Sinai Hospital and Mount Sinai Hospital of Queens, but that's slated to end on Feb. 29, UnitedHealthcare said. Fully insured plans — where the insurer assumes the risk — could lose in-network benefits at Mount Sinai hospitals at that point, too, the insurer said.

The two organizations had a three-year agreement that took effect on Jan. 1, 2022, which has been canceled before it was supposed to expire amid a dispute over payment rates. Both institutions are blaming one another for the standoff.

Mount Sinai claims UnitedHealthcare compensates it an average of 30% less for care than other health systems in New York. The insurer pays New York-Presbyterian $25,911 for a normal vaginal birth, and Mount Sinai $15,989, Mount Sinai said. 

“Mount Sinai must be paid fairly,” spokeswoman Lucia Lee said in a statement. “As Mount Sinai costs substantially less than our peers, UHC/Oxford will actually end up paying more for patients to get care at other systems in New York. This cost — estimated to be at least $140 million more over the course of a year — will be passed on to employers and patients.”

UnitedHealthcare says Mount Sinai sought “outlandish price hikes” that would increase costs for services an average of 50% over three years or $600 million — an estimate disputed by Mount Sinai. For example, a regular, outpatient colonoscopy at South Nassau costs about $6,000 and would be about $8,700 in three years under Mount Sinai's proposal, according to UnitedHealthcare.

The insurer said it proposed alternative price increases, but declined to quantify its offer. 

“As the largest provider of small business health plans in downstate New York, we have a responsibility to ensure the more than 50,000 small businesses we serve in the area can continue to provide their employees with affordable health care benefits,” UnitedHealthcare noted in a webpage detailing its position on the dispute.

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