UnitedHealthcare, Stony Brook Medicine negotiating rates before June 1 deadline

Tens of thousands of UnitedHealthcare policyholders on Long Island may lose their in-network coverage for Stony Brook Medicine on June 1 if the two entities cannot come to an agreement on reimbursement rates.

About 35,000 members "were notified about the current negotiation with Stony Brook," UnitedHealthcare said in an email. United’s Empire Plan members are not affected, but Stony Brook said in a statement that almost all other UnitedHealthcare and Oxford plans are covered in the contracts that expire May 31.

Stony Brook Medicine includes Stony Brook University Hospital, Stony Brook Children’s Hospital, Stony Brook Southampton Hospital and Stony Brook Eastern Long Island Hospital. It also includes 20 physician medical practices, most for specialized care.

The down-to-the-wire negotiations over how much UnitedHealthcare pays Stony Brook hospitals and physician practices for its policyholders’ care is the latest dispute between an insurer and major Long Island health care provider.

In March 2024, UnitedHealthcare and the Mount Sinai system, which includes Mount Sinai South Nassau in Oceanside, reached an agreement days before in-network rates were set to expire.

Stony Brook Medicine said in a statement that it was hopeful. "We continue to work diligently with UnitedHealthcare toward a mutually beneficial settlement and are optimistic that we will come to terms," the statement said.

"We are engaged in productive, good-faith negotiation with Stony Brook Medicine," United said in a statement. "Our top priority is to utilize the remaining time on our contract to reach an agreement that is affordable for consumers and employers while ensuring continued, uninterrupted network access to the health system."

In addition to notifying the roughly 35,000 people who may lose in-network coverage, United acknowledged that it also told some of its Empire Plan members that they risked losing coverage, even though Empire Plan policyholders are not affected.

"These members are currently being contacted and informed that the Empire Plan is not impacted by this negotiation," the company said.

State law requires that policyholders in state-regulated plans — which include fully insured commercial plans and Medicaid plans — maintain in-network access to Stony Brook’s hospitals for an additional two months. Self-funded plans not regulated by the state, which includes many employer and labor union plans, are not covered by the extension. Stony Brook advised policyholders to contact their employer’s health benefits office, UnitedHealthcare or Oxford to confirm which type of plan they have.

State law requires "continuity of care" for 90 days after a provider leaves an insurance network, at inpatient rates, for patients with "a serious and complex condition" for which "treatment would prevent serious harm," for people receiving "a course of inpatient treatment" or treatment for a terminal illness, and for patients scheduled for nonelective surgery. The law requires treatment through the end of postpartum care for pregnant women.

UnitedHealthcare said in an online statement that members who want to know if they would qualify for continuity of care coverage after June 1 should call the phone number on their health plan identification card.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.