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


    New York Presbyterian Queens


    Elmhurst Hospital Center


    New York Presbyterian Weill Cornell


    Flushing Hospital Medical Center


    North Shore University Hospital Manhasset

    Long Island

    Lenox Hill Hospital


    NYU Langone Hospital Brooklyn


    Long Island Jewish Medical Center


    NYU Langone Hospital Long Island

    Long Island

    Maimonides Medical Center


    St. Francis Hospital

    Long Island

    Mercy Medical Center

    Long Island

    St. Johns Episcopal Hospital


    New York Presbyterian Columbia


    St. Joseph Hospital


    New York Presbyterian Lower Manhattan Hospital


    Wyckoff Heights Medical Center



    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.




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    Best Hospitals – Newsweek 2023

    Best Hospitals – Newsweek 2023

    Recently, Newsweek released their annual top hospitals rankings.

    “This year’s rankings represent an expanded universe, with three new countries on the list—Colombia, Saudi Arabia, and the United Arab Emirates—bringing the total to over 2,300 hospitals in 28 countries. And the results show a remarkable cross-section of excellence across the world: Twenty-one countries are represented in the global top 150. The U.S. leads with 29 hospitals, followed by Germany with 16; Italy and France with 10 each; and South Korea with eight. Overall, there were 13 new hospitals in this year’s top 100. Among the biggest movers from last year’s rankings were  No. 8 Northwestern Memorial Hospital (28 in 2022); No. 40 Seoul’s Samsung Medical Center (73) and No. 11 New York’s NYU Langone Hospitals (59).”

    Top 10 Internationally:

    1 Mayo Clinic Rochester-   United States
    2 Cleveland Clinic-    United States
    3 Massachusetts General Hospital-    United States
    4 The Johns Hopkins Hospital-   United States
    5 Toronto General – University Health Network-   Canada
    6 Karolinska Universitetssjukhuset-   Sweden
    7 Charité – Universitätsmedizin-    Berlin Germany
    8 AP-HP – Hôpital Universitaire Pitié Salpêtrière-    France
    9 Singapore General Hospital-     Singapore
    10 UCLA Health – Ronald Reagan Medical Center-    United States


    Top 20 Nationally:

    1 Mayo Clinic – Rochester
    2 Cleveland Clinic
    3 Massachusetts General Hospital
    4 The Johns Hopkins Hospital
    5 UCLA Health – Ronald Reagan Medical Center
    6  Stanford Health Care – Stanford Hospital
    7 Brigham And Women’s Hospital
    8 Northwestern Memorial Hospital
    9 The Mount Sinai Hospital
    10 New York-Presbyterian Hospital-Columbia and Cornell                                                                                                         

    11. University of Michigan Hospitals – Michigan Medicine
    12  Cedars-Sinai Medical Center
    13.  UCSF Medical Center
    14. Duke  University Hospital
    15. Hospital of the University of Pennsylvania – Penn Presbyterian
    16. NYU Langone Hospitals
    17. Mayo Clinic – Jacksonville
    18. Russh University Medical Center
    19. Mayo Clinic – Phoenix
    20. Houston Methodist Hospital

    Top 10 NY/NJ Metro Hospitals:

    9The Mount Sinai Hospital83.98%New YorkNY
    10New York-Presbyterian Hospital-Columbia and Cornell83.94%New YorkNY
    16NYU Langone Hospitals81.23%New YorkNY
    46Morristown Medical Center70.66%MorristownNJ
    57Hackensack University Medical Center69.52%HackensackNJ
    117Strong Memorial Hospital – University of Rochester65.36%RochesterNY
    121Valley Hospital65.30%RidgewoodNJ
    130North Shore University Hospital65.21%ManhassetNY
    148Saratoga Hospital64.71%Saratoga SpringsNY
    167Overlook Medical Center64.42%SummitNJ


    Top 3 CT Hospitals:

    35    Yale New Haven Hospital
    158    St. Francis Hospital & Medical Center
    201    Griffin Hospital

    Top 10 PA Hospitals:

    15Hospital of the University of Pennsylvania – Penn PresbyterianPhiladelphiaPA
    54Jefferson Health – Thomas Jefferson University HospitalsPhiladelphiaPA
    58UPMC Presbyterian & ShadysidePittsburghPA
    64Penn State Health – Milton S. Hershey Medical CenterHersheyPA
    76Penn Medicine Chester County HospitalWest ChesterPA
    103Reading HospitalReadingPA
    116St. Luke’s Hospital BethlehemBethlehemPA
    122Doylestown HospitalDoylestownPA
    153Lancaster General HospitalLancasterPA
    168Main Line Health – Lankenau Medical CenterWynnewoodPA

    Top 10 FL Hospitals:

    17Mayo Clinic – JacksonvilleJacksonvilleFL
    45Cleveland Clinic – FloridaWestonFL
    84Tampa General HospitalTampaFL
    146Sarasota Memorial HospitalSarasotaFL
    149St. Joseph’s Hospital – BayCareTampaFL
    172Baptist Health Baptist HospitalMiamiFL
    176Morton Plant HospitalClearwaterFL
    179Baptist Medical Center – BeachesJacksonville BeachFL
    183Adventhealth OrlandoOrlandoFL
    215Cape Canaveral HospitalCocoa BeachFL

    NOTE: For patients and their physicians, these rankings and ratings should be seen as just a starting point. While this is helpful information to have, benefit plan participants should also research quality hospitals using transparency tools if these services are available through the health plan or benefits package. For a customized review of your commercial sponsored plan using latest tools and third part-tools please contact us today.

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

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    Montefiore and Oxford Reach Agreement

    Montefiore and Oxford Reach Agreement

    ​Good news Bronx/Westchester.  Oxford and Montefiore Health System announced moments ago that they have reached an agreement effective December 1, 2021 for UnitedHealthcare and Oxford employer-sponsored plans, as well as UnitedHealthcare’s Medicare Dual Special Needs Plan.  

    This resolves a split since Jan 1, 2021 which affected a significant percentage of local residents as both companies have a critical size of the market. Westchester and Bronx populations total nearly 2.5 million people. While this contract is resolved with titanic and a few Hospital Systems and Insurers left in the market we expect to see this trend to continue.

    See below the official press release. 


    UnitedHealthcare and Montefiore Health System Renew Relationship

    UnitedHealthcare and Montefiore Health System have reached a multi-year agreement that restores access to Montefiore’s hospitals and physicians for people enrolled in UnitedHealthcare and Oxford employer-sponsored plans as well as UnitedHealthcare’s Medicare Dual Special Needs Plan, effective Dec. 1, 2021.

    We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them. Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.

    We thank our members and customers for their support and patience throughout this process. We are honored to continue supporting the more than 3.7 million individuals across New York who depend on us for access to quality and affordable health care.

    Montefiore Hospitals & Health System

    Facility NameCounty
    Montefiore Hospital (Moses Campus)Bronx
    Children’s Hospital at MontefioreBronx
    Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical CenterBronx
    Montefiore Wakefield Hospital (Wakefield Campus)Bronx
    Burke Rehabilitation HospitalWestchester
    Montefiore Mount Vernon HospitalWestchester
    Montefiore New Rochelle HospitalWestchester
    Montefiore Nyack HospitalRockland
    Montefiore St Luke’s Cornwall HospitalOrange
    White Plains HospitalBronx
    Montefiore Hutchinson CampusBronx
    Montefiore Medical GroupWestchester
    Montefiore Medical Specialists of WestchesterWestchester


    Neighboring Hospitals

    Facility NameCounty
    Bon Secours Community Hospital
    BronxCare Hospital Center
    Garnet Health Medical Center
    Good Samaritan Hospital of Suffern
    New York Presbyterian Hudson Valley Hospital
    New York Presbyterian Lawrence Hospital
    NYC Health + Hospitals Jacobi
    NYC Health + Hospitals Lincoln
    NYC Health + Hospitals North Central Bronx
    St. Anthony Community Hospital
    St. Barnabas Hospital
    St. John’s Riverside Hospital
    Westchester Medical Center

    Leading Health Insurers 

    2021 Empire Blue Cross Blue Shield
    2021 EmblemHealth 
    2021 Healthfirst Plans
    2021 New Oscar Circle Plus





    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.

    2018’s Top Ten Best & Worst States for Health Care

    2018’s Top Ten Best & Worst States for Health Care

    2018’s Top Ten Best & Worst States for Health Care

    Vermont is the best state for healthcare, according to an 2018’s Best & Worst States for Health Care  analysis by WalletHub.

    To identify the best and worst states for healthcare, WalletHub analysts compared the 50 states and the District of Columbia on 40 key metrics of healthcare cost, accessibility and outcomes. The metrics range from physicians per capita to average monthly insurance premiums. Each measure was graded on a 100-point scale, with 100 representing the best healthcare at the most reasonable cost.

    Here are the 10 best states for healthcare based on the analysis: 2010 Worst 10 Sates Healthcare

    1. Vermont

    2. Massachusetts

    3. New Hampshire

    4. Minnesota

    5. Hawaii

    6. Rhode Island

    7. Colorado

    8. District of Columbia

    9. Iowa

    10. Maryland

    Here are the 10 worst states for healthcare based on the analysis:

    1. Louisiana

    2. Mississippi

    3. Alaska

    4. Arkansas

    5. North Carolina

    6. Alabama

    7. Oklahoma

    8. South Carolina

    9. Georgia

    10. Florida

    Access additional information on the metrics used for the analysis here.

    Top 10 medical innovations for 2017

    Top 10 medical innovations for 2017

    Top 10 medical innovations for 2017

    The Cleveland Clinic announced its list of the top 10 medical innovations for 2017  that have the potential to transform healthcare.cleveland-clinic

    The 11th annual list was announced Wednesday during the Cleveland Clinic 2016 Medical Innovation Summit, held this week at the Huntington Convention Center of Cleveland and the adjacent Global Center for Health Innovation.

    A team of more than 100 doctors and researchers assembled by the Clinic examined nearly 200 nominations to identify and rank the top 10 innovations. The panel doesn’t highlight brands or companies, but rather the innovation and its potential applications in healthcare.

    The Top 10 Medical Innovations of 2017 are listed below in order of anticipated importance:

    1. Using the microbiome to prevent, diagnose and treat disease

    Trillions of bacteria in the body make up communities known as the microbiome. Within the last 10 years, researchers have discovered that the chemicals microbes emit can interfere with how food is digested, medicine is deployed or how a diseases progresses.

    The National Microbiome Initiative has accelerated research and development, and biotech companies are looking at the microbiome’s potential to develop new diagnostics or therapies and probiotic products to prevent microbe imbalances.

    Experts believe that next year the microbiome will solidify itself as “the health care industry’s most promising and lucrative frontier,” according to a news release.

    2. Diabetes drugs that reduce cardiovascular disease and death

    In the past, medications have fallen far short of addressing the mortality rates for type 2 diabetes. Half will die from complications from cardiovascular disease. Those odds reach 70% after the age of 65. But new medications began dropping mortality rates this year.

    Empaglifozin modifies the progression of heart disease by working with the kidneys, and liraglutide has a comprehensive effect on many organs, according to the release.

    2017 could bring a complete shift in the medicines prescribed and further research into new ways to target type 2 diabetes, experts predict.

    3. Cellular immunotherapy to treat leukemia and lymphomas

    One of the first cellular immunotherapies is about to hit the market, and early results suggest leukemia and non-Hodgkin lymphomas might be curable, even in advanced stages, according to the release.

    Chimeric antigen receptor (CAR) T-cell therapies are a form of immunotherapy in which T-cells are removed and genetically reprogrammed to find and destroy tumor cells. After attacking and killing foreign cancer cells, they often remain to minimize the risk of relapse.

    The treatment, results for which have been impressive, is expected to be presented to the U.S. Food and Drug Administration next year for treatment for acute lymphoblastic leukemia.

    4. Liquid biopsies to find circulating tumor DNA

    “Liquid biopsies” are blood tests that uncover signs of actual DNA, or cell-free circulating tumor DNA (ctDNA), which is shed from a tumor into the bloodstream and is more than 100 times more abundant in blood than tumor cells.

    Several companies are developing testing kits expected to hit the market this year.

    Liquid biopsies are being hailed as a flagship technology of the Cancer Moonshot Initiative, a national effort to end cancer.

    5. Automated car safety features and driverless capabilities

    New automatic safety features could make a dent in dangerous car accidents, which remain a leading cause of death and disability as well as a major expense. In 2015, there were 38,300 fatal car crashes in 2015, and medical costs nationwide in one year total nearly $23 billion nationwide.

    The automated features include collision warning systems, drowsiness alerts and adaptive cruise control. More are likely coming.

    Though legal and safety questions remain, major investments into driverless cars are being made by software, private transportation and auto manufacturing companies.

    6. Fast healthcare interoperability resources

    For many years, billing departments, doctors’ offices, insurance companies and more have operated with systems that couldn’t talk with each other. Experts predict that 2017 is the year to make sense of this tangled web.

    An international committee called HL7 will soon release a new tool, FHIR (Fast Healthcare Interoperability Resources), which will serve as an interpreter between systems or offices. The first release will focus on clinical data while the second will look at administrative data, with the potential to end a lot of frustration.

    7. Ketamine for treatment-resistant depression

    For one third of patients with depression, medications don’t work. Alternatives include intensive treatment options, such as electroconvulsive therapy.

    Initial studies of ketamine, a drug commonly used for anesthesia, indicated that 70% of patients with treatment-resistant-depression (“TRD”) saw an improvement in symptoms within 24 hours of a low-dose injection. Ketamine, also known in the 1960s as a party drug, was studied for its ability to target and inhibit the action of N-methyl-D-aspartate (“NMDA”) receptors of nerve cells.

    The FDA granted Fast Track Status to the development of a new NMDA-receptor-targeting medications based on the ketamine profile. The FDA gave some, like esketamine, breakthrough status, enhancing the potential for these drugs to be available to patients in 2017.

    8. 3D visualization and augmented reality for surgery

    Two of the most intricate surgical practices, ophthalmology and neurology, began experimenting in the past year with technology that allows surgeons to keep their heads up while using high-resolution, 3D visual representations of their subjects.

    Using data, stereoscopic systems create visual templates. Surgeons who’ve piloted the technology say it brings added comfort and visual information that allows them to operate more effectively and efficiently while also giving medical residents a clear picture of what they’re doing.

    Augmented reality glasses that display holographic images of human anatomy could bring the end of cadaver labs at medical schools.

    Along the same lines, software companies are building augmented reality glasses that display holographic images of human anatomy. Medical schools see the end of cadaver labs. The Clinic and Case Western Reserve University were among the early adopters to work with Microsoft’s HoloLens, a mixed reality device that allows users to interact with holograms.

    9. Self-administered HPV test

    Most sexually active woman contract the human papilloma virus (HPV), certain strains of which are responsible for 99% of cases of cervical cancer. The most common malignancy is in women 35 years and younger.

    HPV prevention and treatment, which have made great strides, are restricted to women who have access to tests and vaccines.

    An approach to expand that care will launch in 2017 with self-administered HPV test kits developed by scientists with the idea that women can mail samples to a lab and be alerted to dangerous HPV strains.

    10. Bioabsorbable stents

    In July, the first bioabsorbable stent was approved in the U.S. The stent, made of a naturally dissolving polymer, widens clogged arteries for two years before being absorbed much like dissolvable sutures, leaving behind a healthy natural artery.

    Annually 600,000 people are treated for coronary artery blockage with metal coronary stents, which stay in their chests permanently most of the time. These stents may inhibit natural blood flow or cause other complications.

    Experts believe the market potential for absorbable stents will approach $2 billion in six years.

    Cleveland Clinic announces top 10 medical innovations for 2017” originally appeared in Crain’s Cleveland Business.

    Mergesurance Mania

    Mergesurance Mania

    Mergersurance Mania

    Insurance mergers aka Mergersurance Mania continues at a steady pace with April 2016 Florida’s approval of Anthem Blue Cross and CIGNA merger.  This is one month after Florida approved the Aetna and Humana merger.  Investors have given their blessings to be sure while 10 States have also given approval. The Anthem Cigna $54 billion merger leaves only three national major providers of health care. Worries remain about the potential effect on consumers and the rising cost of health care.Hospital Mergers

    Health Insurers consolidation argument are that they need to be able to  merge in order to absorb added costs and blunted profit margins under the Affordable Care Act.  Additionally, medical groups and hospitals groups have merged themselves rapidly giving them negotiation cost controls. This has traditionally been trending in smaller regional markets but are now also felt in major US Cities.

    Evidence indeed is pointing to expected large insurance increases due to overwhelming market domination by hospitals. While Doctors and AMA are rightfully concerned about Insurer mergers the vast majority are now working for a Hospital System or Medical IPA.

    Without public outcry there seems to be lax Regulator oversight and the  arms race should not come as a surprise.  On the local level we have yet to see a recent example of hospital merger that was curtailed.

    This goes well beyond political partisanship. In a tight Presidential race it is important to understand that whether or not one supports a Single Payer we all suffer.  This is bad for consumers, providers and tax payer all around.  In an Oligopoly health care system with lack of competition the U.S. tax payers are also stuck with inflated costs.

    Past Articles:

    Breaking: Maimonides North Shore LIJ Partnership Aug 2015
    Montefiore Buying Sound Shore Hospital  May 2013
     NYU Beth Israel Hospital Merger and ACO June 2012
    HIP/GHI Merger Mar 2008