Thousands of Long Islanders could lose in-network healthcare at Northwell Health

Fidelis and Wellcare will no longer cover care at Northwell Health facilities later this summer, after a contract between the insurance company and healthcare network expired earlier this month.

If not resolved in the coming weeks, the contract dispute threatens to leave thousands of Long Islanders — many of whom are low-income residents on publicly insured health plans — without in-network access to one of the state’s largest healthcare providers.

Fidelis, a subsidiary of the insurer Centene, covers 2.4 million New Yorkers, according to the company. Those are largely patients on Medicaid, marketplace plans and the state’s Essential Plan — which covers low-income patients who make too much to be eligible for Medicaid — as well as people insured with Medicare plans under the linked Wellcare brand. 

According to state data, Fidelis covers nearly 220,000 people in Nassau and Suffolk counties with its Medicaid plans, marketplace plans, and Essential Plan insurance. A Fidelis spokesperson did not respond to a question about the total number of Long Islanders it insured. 

Northwell, of New Hyde Park, boasts a network of 28 hospitals and over 1,000 outpatient facilities, according to its website. On Long Island alone, the network operates nearly a dozen hospitals, including facilities in New Hyde Park, Port Jefferson, Manhasset, Bay Shore and Glen Cove. It also runs many outpatient centers. 

It describes itself as the state’s largest healthcare network and its largest private employer.

The two sides pointed fingers at each other this week in statements to Newsday.

Barbara Osborn, a spokesperson for Northwell, said that, during negotiations, "Fidelis proposed reimbursement rates that fall well below the actual cost of delivering care."

Meanwhile, Glenn Teichman, a Fidelis spokesperson said, "The rates Northwell is seeking significantly exceed those paid to comparable providers and do not reflect a sustainable approach for government-funded programs."

The contract expired May 15, according to Northwell. People insured with Fidelis and Wellcare will be able to continue to receive care through June and at least part of July, and potentially August for some "established" patients, according to informational webpages set up by Northwell. 

Both parties said they are still willing to negotiate a deal to keep the insurers in network at Northwell. But if no deal is reached, Fidelis and Wellcare members will soon be charged significantly higher, out-of-network rates at Northwell facilities. 

The shift will not affect patients at former Nuvance Health facilities — including Connecticut facilities and several hospitals in the Hudson Valley — which merged with Northwell last year, Hospitals are prohibited from turning away patients in emergencies, and patients are protected from being billed at out-of-network rates in such emergency situations. 

State law also requires that people insured by state-regulated plans — which include Medicaid plans — continue to have access to Northwell’s hospitals for two months after the contract expires.

State law also requires "continuity of care" for 90 days at in-network rates for patients with "a serious or complex condition" for which "treatment would prevent serious harm," for those in treatment for a terminal illness, for patients scheduled for nonelective surgery and for those undergoing "a course of inpatient treatment." It also requires treatment for pregnant women through the end of postpartum care.

Danielle De Souza, a spokesperson for the New York Department of Health, said the dispute "should have no significant impact on the members, because there are other network hospitals within the Fidelis network available to members disrupted by the termination."

Fidelis "would make arrangements for the disrupted members' care and services to be resumed among other hospitals within this network," De Souza said.

But Lara Kassel, coalition coordinator of Medicaid Matters, a statewide coalition of organizations that advocate for Medicaid members, said the impact on patients could be substantial.

"This is an enormous change given the size of the health system and the size of the coverage itself," she said. "Fidelis serves an enormous amount of people, and losing the providers within that network will be significant for the people who are covered by Fidelis." 

At Harmony Healthcare Long Island, where more than half the patients are on Medicaid, "Fidelis is a really big payer for us," said David Nemiroff, president and CEO of the organization, which serves nearly 49,000 people a year and has nine nonprofit health centers in Nassau County.

When Harmony refers patients to specialists, it refers some — although not most — to Northwell practitioners, he said.

If July 15 passes without an agreement between the health plans and Northwell, "we would look at the Fidelis list of in-network facilities and work with the patient to at least refer them," he said. "Patients can choose to go anywhere."