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Update: Oxford/United and Mt Sinai Health Systems Split

Update: Oxford/United and Mt Sinai Health Systems Split

Recently, UHC/Oxford and Mt Sinai Health System had split effective January 1, 2024.  Since that time there have been a state-required cooling-off period and ongoing talks on resolution but that has not yielded a positive outcome yet.  The Mount Sinai Hospital, Mount Sinai Queens, and their related hospital outpatient locations will remain in-network for all patients until at least Friday, March 1.

According to UnitedHealthcare/Oxford: 

  • People enrolled in UnitedHealthcare fully insured commercial plans have continued network access to all of Mount Sinai’s hospitals through Feb. 29, 2024, due to New York cooling-off requirements.
  • Unless they obtain admitting privileges to another in-network hospital, the majority of Mount Sinai’s physicians will no longer participate in our network for employer-sponsored and individual plans, including the Oxford Health Plan, effective March 22, 2024.
  • This negotiation only impacts our relationship with Mount Sinai for employer-sponsored and individual commercial plans, including Oxford. All other active contracts, including Medicare Advantage and the Empire Plan, remain in place with no change.

The two organizations had a three-year agreement that took effect on Jan. 1, 2022, which was 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.

    Mt Sinai Hospitals & Health System

    Facility NameCounty
    Mount Sinai Beth IsraelNYC
    The Mount Sinai HospitalNYC
    Mount Sinai MorningsideNYC
    The Mount Sinai WestNYC
    Mount Sinai-Union SquareNYC
    Mount Sinai Kravis Children’s HospitalNYC
    Mount Sinai-Behavioral Health Center (MSBHC)NYC
    Blavatnik Center, Medical CenterNYC
    New York Eye and Ear Infirmary of Mount Sinai NYC
    Mount Sinai BrooklynBrooklyn
    Mount Sinai QueensQueens
    Mount Sinai South NassauLong Island

     

    Neighboring Hospitals

    Bellevue Hospital Center

    NYC

    New York Presbyterian Queens

    Queens

    Elmhurst Hospital Center

    Queens

    New York Presbyterian Weill Cornell

    NYC

    Flushing Hospital Medical Center

    Queens

    North Shore University Hospital Manhasset

    Long Island

    Lenox Hill Hospital

    NYC

    NYU Langone Hospital Brooklyn

    Brooklyn

    Long Island Jewish Medical Center

    Brooklyn

    NYU Langone Hospital Long Island

    Long Island

    Maimonides Medical Center

    Brooklyn

    St. Francis Hospital

    Long Island

    Mercy Medical Center

    Long Island

    St. Johns Episcopal Hospital

    Queens

    New York Presbyterian Columbia

    NYC

    St. Joseph Hospital

    Queens

    New York Presbyterian Lower Manhattan Hospital

    NYC

    Wyckoff Heights Medical Center

    Brooklyn

     

    Both sides need each other as both are market leaders in their fields. It is our hope and most of our clients that they get this resolved soon. In the meantime, please bookmark our site for the latest updates.  And do reach out to us and learn the steps that you can take to smoothen this temporary roadblock.

    Resources:

    https://www.uhc.com/sinai

    https://keepmountsinai.org/

    For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

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    NYS DFS 2024 Rates Approved

    NYS DFS 2024 Rates Approved

    Earlier today, the long-awaited NYS Dept of Financial Services approved 2024 health insurance rate requests. And it was worth it with small groups stabilized.  Small group rates increased by 7.4% and  12.4% for individuals.

    As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers. Despite only 3 months of mature claims data experience for 2023  health insurers’ original requests were noticeably above the average of 22%/individuals and 15.3% for small groups.

    State Department of Financial Services officials asserted the rising cost of medical care — including in-patient hospital stays and rapid increases in drug prices — continued to be the main driver of health insurance premium increases. The final approved rates for 2024 would keep health insurers’ profit provisions at 1%, state officials added, noting they sought to limit those returns in light of ongoing inflationary pressures harming consumers. That said, in anticipation of spikes in claims submissions + overall inflation, a larger-than-average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

    Rate Factors

    The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial well-being of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ healthcare costs and the economy, held insurers’ profit provisions to a low 1%. 

    Health Insurers

    Oxford/Unitedhealthcare, notably, got only a 4.7% rate increase approval for next year. This is a sharp reduction from the original 15.5% request in part to disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

    Small Group Market   

    Almost 800,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 15.3% in the small group market, which DFS cut by 52% to 7.4% for 2024, saving small businesses $607 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

    DFS SMALL GROUP MARKET RATE ACTIONS   

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    *Indicates the Company will offer products on the NY State of Health Marketplace in 2024.

    PEO Alternatives to Small Group

    Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEOs are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

    Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

    Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make a difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

     

     

     

     

    Put You & Your Employees in Good Hands

    Get In Touch

    For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

    NY Paid Family Rate & Benefit 2023

    NY Paid Family Rate & Benefit 2023

    NY Paid Family Rate & Benefit 2023

    The New York Department of Financial Services has released the 2023 PFL benefit and rates.

    The PFL rate to .455% of taxable wages. The maximum an employee will contribute in 2023 will be: $399.43/year

    The PFL maximum benefit will increase to:  67% of the average weekly wage to a maximum $1131.09/week. 

    Duration remains the same at 12 weeks.

    The Statewide Average Annual Wage cap increases to $87,785.88 ($1688.19 per week).

    Learn more about how we are successfully helping navigate SMB for 20+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

    For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

    Put You & Your Employees in Good Hands

    Get In Touch

    For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

    NYS 2023 Final Rates Approved

    NYS 2023 Final Rates Approved

    Yesterday, NYS Dept of Financial Services approved 2023 health insurance rate requests yesterday. Small group rates increased by 7.9% and  9.7% for individuals.

    As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –2023 NY Small Group Carrier Rate Filings.  Despite only 3 months of mature claims data experience for 2022  health insurers’ original requests were noticeably above the average of 16.5%/individuals and 19% for small groups. For example, regulators last year approved average rate increases of 3.7% for individuals and 7.6% for small group plans. Over 1.1 million New Yorkers are enrolled in individual and small group plans impacted by the rate increases, the state agency noted.  

    The recent COVID-19 surge irony reflected a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% in recent years years. That said, in an anticipation of spikes in claims submissions + overall inflation, a larger than average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

    Rate Factors

    The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial wellbeing of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ health care costs and the economy, held insurers’ profit provisions to a historically low 0.5%. 

    Health Insurers

    Oxford/Unitedhealthcare, notably, got only a 6% rate increase approval for next year. This is a sharp reduction from the original 16.8% request in part by disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

    Small Group Market   

    Almost 850,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 16.5% in the small group market, which DFS cut by 52% to 7.9% for 2023, saving small businesses $632.4 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

    DFS SMALL GROUP MARKET RATE ACTIONS   

    NYS DFS Approval 2023 Health Insurance Rates

    *Indicates the Company will offer products on NY State of Health Marketplace in 2023.

    PEO Alternatives to Small Group

    Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

    Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

    Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

     

     

     

     

    Put You & Your Employees in Good Hands

    Get In Touch

    For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

    CareMount Medical Now on Empire Blue Access and Connection Networks

    CareMount Medical Now on Empire Blue Access and Connection Networks

    On September 1, 2022, Empire BlueCross BlueShield will begin partnering with CareMount Medical, the largest independent, multi-specialty group in New York State, to provide access to affordable care throughout New York City, Westchester, Putnam, Dutchess, Columbia, and Ulster counties.

    CareMount will now be part of Empire’s Blue Access and Connection Networks for all Large Group and Small Group members. This will mean greater access to more affordable care throughout Westchester and surrounding markets.

    Contact us to learn how Empire can fit your employee’s needs.  

    Empire Strikes Back – 2022 Health Plans

    Learn more about how we are successfully helping navigate SMB for 25+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

    For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

    Put You & Your Employees in Good Hands

    Get In Touch

    For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

    2023 NY Small Group Carrier Rate Filings

    2023 NY Small Group Carrier Rate Filings

    Last month NYS received the rate filing requests below as per annual Dept of Financial Services requirements. Your insurer has mailed notices about their rate filings (requested rates) to impacted New York small business certificates and policyholders with renewal dates in 2023.

    Below is a listing by carrier of requested rates for 2023 and a link to their sample notification letters.

    Note: These are just the requested rate changes filed with the DFS and are not final.

    Carrier

    Requested Rate Change

    Link to sample notices

    Aetna30.60%Aetna Link
    Emblem (HIP)19.00%Emblem Link
    Empire BCBS17.60%Empire BCBS Link
    Healthfirst15.00%Healthfirst Link
    Oscar19.40%Pending
    Oxford/UHC16.80%Oxford/UHC Link
    Weighted Average19.73%N/A

    Final approval is expected next month. Join our newsletter to stay updated on the latest news.

    For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

    Summary

    Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well.

    Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

     

     

    Put You & Your Employees in Good Hands

    Get In Touch

    For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP.