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February 2010Update on UHC/Oxford Negotiations
with Continuum Health Partners
with Continuum Health Partners
As reported in a previous eALERT from November, Oxford Health Plans & UnitedHealthcare (UHC) have been in negotiations for new contracts on all lines of business with Continuum Health Partners (Continuum), a five hospital system located in Manhattan and Brooklyn, consisting of Beth Israel Medical Center-Petrie Division, Beth Israel Medical Center- Kings Highway Division, Long Island College Hospital, New York Eye and Ear Infirmary and St. Luke’s Roosevelt Hospital.
C&B would like to take this opportunity to update you on recent developments in the wake of a recent court ruling. This well help clarify the participation status of Continuum hospitals, physicians that have admitting privileges to only Continuum hospitals, and physicians that have admitting privileges to Continuum as well as additional hospital facilities.
Hospital Services: (Dates of Service: 1/1/10 – 2/28/10)
Impact on ASO Members:
Inpatient and outpatient elective services will be subject to the member’s out-of-network benefits, if any. The only exceptions are as follows: emergency services, transitional care, and if UHC expressly authorizes or approves a member to receive services at a Continuum hospital. These exception claims would be paid subject to the member’s in-network benefits.
Impact on Fully Insured Members:
These members are subject to the New York State cooling off period. As a result, inpatient and outpatient services will be subject to the member’s in-network benefits.
Hospital Services: (Dates of Service: 3/1/10 – 4/30/10)
Impact on both ASO and Fully Insured Members:
Inpatient and outpatient hospital services will be subject to the member’s out-of-network benefits, if any. The only exceptions are as follows: emergency services, transitional care, and if UHC expressly authorizes or approves a member to receive services at a Continuum hospital. These exception claims would be paid subject to the member’s in-network benefits.
The scenarios above apply regardless of whether the member was admitted or referred by a physician who only has admitting privileges at a Continuum hospital or a physician who has admitting privileges at both a Continuum hospital and another hospital that is participating in UHC’s network.
When reviewing claims for emergency services, UHC will request medical records to confirm such services are emergency services. UHC will also direct members, as appropriate, to participating hospitals.
Physician Services: (Dates of Service: 1/1/10 – 4/30/10)
Impact on both ASO and Fully Insured Members:
All claims for services delivered by physicians that only have admitting privileges at Continuum hospitals will be paid on an in-network basis subject to the member’s benefits.
C&B will continue to keep you informed of further developments in these negotiations. In the meantime, if you have any questions, please contact us.
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