SCHENECTADY (NEWS10) - A patient is facing uncertainty over his upcoming surgery at St. Peter's Health Partners due to the contract dispute with UnitedHealthcare, which has left him without in-network coverage for his critical procedure.
"Two years ago, I developed a condition that needed immediate surgery," the patient recalled. "My insurance covered everything, and I've been seeing the doctor every six months. Last month, they found the problem had returned."
His scheduled surgery for July 11th at St. Peter's became uncertain when he received a distressing call: St. Peter's was no longer in network with UnitedHealthcare as of July 1st. "I nearly had a heart attack because the surgery could be life-threatening if not addressed."
The patient was directed to the surgical coordinator at Capital Region Urology, "she told me that I could change doctors and hospitals, but to me, that's not an option. With the condition I have, you develop a relationship with your doctor. My doctor works out of St. Peter's. I don't want to go to another doctor if I can avoid it."
He continued, "I called UnitedHealthcare, as the surgical coordinator at St. Peter’s Urology had advised. It was incredibly hard to get in touch with someone or to get a call back. When I finally reached them, they told me my procedure wouldn't be covered because it's scheduled after July 1. They said I could find another doctor or pay out of pocket."
In response to the breakdown in negotiations, UnitedHealthcare published on their website, "Despite extensive efforts, we were unable to reach an agreement with St. Peter’s Health Partners." They clarified that starting July 1, 2024, St. Peter’s physicians and facilities are out of network for most plans, except those under Medicaid.
St. Peter’s Health Partners, owned by Trinity Health, cited efforts to find a middle ground. "We regret that negotiations with UnitedHealthcare did not yield an agreement," they stated. "We made efforts to negotiate fair rates that reflect the quality care we provide."
Despite the impasse, UnitedHealthcare assured members of support during transitions: "Our focus is on ensuring families have access to care through continuity or finding new providers," they assured.
Trinity Health, the company that owns St. Peter's, is also negotiating with UnitedHealthcare in Connecticut and Massachusetts. Patients covered by UnitedHealthcare plans may experience disruptions as of July 1st.
