UnitedHealthcare/Oxford Contract with East End Hospitals in Jeopardy of Cancellation

The East End Health Alliance Hospitals (Southampton, Peconic Bay and Eastern Long Island) and UnitedHealthcare/Oxford are currently in good faith efforts to negotiate a new contract.  If they are unable to reach an agreement the current agreement may terminate on July 15, 2011.

In the event of a contract termination, the State of New York requires insurance carriers and hospitals to observe a two month “cooling off period,” which is simply a period of time after the termination of a contract when fully insured commercial and Medicare members can still access the terminated hospitals on an in-network basis in the hopes that the hospital and the carrier can reach a new agreement.

Since this cooling off period does not apply to commercial self-funded groups and members, in the event of a termination, EEHA would become non-participating for those members on July 15, 2011. For fully insured commercial, Medicare and Medicaid members, EEHA, and physicians without admitting privileges somewhere other than an EEHA hospital, would become non-participating on September 15, 2011

UnitedHealthcare/Oxford will have Transitional Care guidelines in place so members who have scheduled or ongoing medical treatments at EEHA hospitals will continue to get care as appropriate.

Fully insured commercial, Medicare and Medicaid members would continue to have access to EEHA hospitals on an in-network basis through the New York State cooling off period, which would end September 15, 2011. Transitional Care may be available after the cooling off period in accordance with the member’s Certificate of Coverage.

After July 14, 2011, a primary care physician or specialist should not refer members to an EEHA hospital for any treatment or test. Instead, members should be referred to one of the major neighboring hospitals in the network listed below.

Brookhaven Memorial, John T. Mather Hospital, St. Charles Hospital, Stony Brook University Medical Center, St. Catherine of Siena Medical Center and Southside Hospital.

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