UnitedHealthcare/Oxford and Continuum Health Partners (CHP) have provided notice to one another of their intent to terminate their agreement effective January 1, 2010. This termination will apply to UnitedHealthcare and Oxford commercial products, as well as the Medicare and Medicaid lines of business.
A two month, state-mandated cooling off period will apply to all fully-insured, commercial, Medicare and Medicaid members, which means that all fully-insured members will continue to have access to Continuum facilities on an in-network basis through February 28, 2010. Fully-insured commercial members and their employers who have visited a Continuum hospital in the past 12 months, as well as those who live in the area surrounding a Continuum hospital, will be notified of the termination. Medicare and Medicaid members who have received services from a Continuum hospital in the past 12 months also will be notified of the termination.
UnitedHealthcare and Oxford will continue to negotiate in good faith with Continuum Health System and will make every effort to reach a mutual agreement prior to the termination date of February 28, 2010, for fully-insured membership.
Hospitals in the Continuum Health System include:
- Beth Israel Medical Center
- Roosevelt Hospital
- St. Luke's Hospital
- Long Island College Hospital
- The New York Eye and Ear Infirmary
WHAT THIS MEANS TO YOU AS AN EMPLOYER?
Below is the important information you and your employees need to know regarding this change to your employer-sponsored health plan.
- Through February 28, 2010, to help minimize any disruption this may cause you and to provide you sufficient time to arrange care at another UnitedHealthcare and Oxford participating hospital, care received at Continuum hospitals will be considered in-network.
- Effective March 1, 2010, and consistent with UnitedHealthcare and Oxford’s standard policy, care for an emergency illness, injury or condition will be treated as in-network care at any hospital. However, you may be transferred to a network hospital once your condition stabilizes. Furthermore, any non-emergent care that you receive from Continuum hospitals, other than Continuity of Care (see below), may be covered as out-of-network or denied (if you do not have out-of-network coverage). If you have a plan with out-of-network benefits, higher deductibles and coinsurance may apply. Exceptions include:
- If you or your physician receives an authorization from UnitedHealthcare and Oxford prior to March 1, 2010, to receive inpatient or outpatient hospital services (where such services require authorization) at a Continuum hospital that will occur on or after March 1, 2010, authorization will be honored and the authorized services will be covered at an in-network benefit level provided that you are an otherwise eligible member and no other exceptions allowed under law apply. However, no authorizations for services at a Continuum hospital on or after March 1, 2010, will be provided unless Continuity of Care has been granted.
- Furthermore, if you or your physician provides notification to UnitedHealthcare and Oxford prior to March 1, 2010, that you will be receiving inpatient or outpatient hospital services at a Continuum hospital on or after March 1, 2010, the notification will be recorded by UnitedHealthcare and Oxford, but at the out-of-network benefit level (if you have out-of-network benefits) unless Continuity of Care has been granted. Coverage for such services is conditional on the member having out-of-network benefits.
- Approval for Continuity of Care in accordance with the terms of your Certificate of Coverage:
- If you are receiving an ongoing course of treatment or are hospitalized at a Continuum hospital on or beyond December 31, 2009, you may be entitled to Continuity of Care. This means your care may be covered for a period for up to 90 days (or longer for a complete course of chemotherapy or radiation therapy) beginning January 1, 2010; or
- If you are in your second or third trimester of pregnancy on February 28, 2010, and assuming that you remain eligible for coverage with UnitedHealthcare and Oxford, your care may be covered for a period that includes postpartum care directly related to your delivery.
As noted in your Certificate of Coverage, Continuum must agree to abide by the terms of the former agreement (provide covered services and abide by UnitedHealthcare and Oxford policies and procedures) and must agree to accept UnitedHealthcare and Oxford’s contracted rate as payment in full.
Important: You or your provider must request Continuity of Care to be evaluated for it. Please call Customer Care at the telephone number on your member ID card for details about Continuity of Care, including how to make a request for Continuity of Care if you believe it is warranted. (Language refers to the Continuity of Care benefits of New York members. If you are not a member of a New York Plan, you must refer to the Continuity of Care benefit described in your Certificate of Coverage.)
Please note that UnitedHealthcare and Oxford will continue good faith efforts to negotiate a new contract with Continuum hospitals and will notify you if they reach a new agreement. However, after February 28, 2010, a primary care physician or specialist should not refer you to Continuum hospitals for any treatment or test. Instead, you should be referred to one of the major neighboring hospitals in our network, as listed below.
Neighboring Hospitals in Manhattan
- Bellevue Hospital
- Harlem Hospital
- Hospital for Special Surgery
- Lenox Hill Hospital
- Manhattan Eye, Ear & Throat Hospital
Memorial Hospital for Cancer and Allied Diseases (also known as Memorial
Sloan-Kettering)
- Metropolitan Hospital Center
- Mount Sinai Medical Center
- New York Downtown Hospital
- New York Presbyterian Hospital - Columbia University Medical Center
- New York Presbyterian Hospital - Weill Cornell Medical Center
- NYU Hospital for Joint Diseases
- NYU Hospitals Center (Rusk Institute & Tisch Hospital)
- St. Vincent’s Hospital & Medical Center
Neighboring Hospitals in Brooklyn
- Coney Island Hospital
- Kingsbrook Jewish Medical Center
- Kings County Hospital Center
- Lutheran Medical Center
- Maimonides Medical Center
- New York Community Hospital of Brooklyn
- The Brooklyn Hospital Center
- The New York Methodist Hospital
- University Hospital of Brooklyn
- Woodhull Medical and Mental Health Center
- Wyckoff Heights Medical Center
WHAT SHOULD I DO NEXT?
Please communicate this important information to your enrolled employees.
If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or click CLICK HERE to contact us today.
Corporate Synergies is pleased to provide regular updates on issues affecting group benefits insurance. As an insurance broker and consultant, Corporate Synergies is proactive in monitoring federal and state legislative and regulatory activity to ensure that you stay informed. Our customers call us their “Dedicated Advocates”. We work on your behalf. |
