St.Peter’s and UnitedHealtcare end payment standoff, reach agreement
ALBANY - St. Peter's Health Partners, which includes St. Peter's Hospital, and the UnitedHealthcare insurance company have reached an agreement, after a months-long standoff, allowing people covered by the insurer to have continued access to the hospital's network.
News of the agreement, announced in a brief written statement on Friday from SPHP, means that scores of United Healthcare customers won't have to shop around for a new health insurer if they want to use St. Peter's expansive health care network in the Capital Region.
"SPHP is excited that we have reached an agreement with UHC. In today's health care environment, it is critically important that payers and providers collaborate on behalf of our patients," Dr. Steven Hanks, president and CEO of St. Peter's Health Partners and St. Joseph's Health, said in a prepared statement. "Our goal has always been to come to a resolution that allows SPHP and UHC to continue to meet the needs of our patients and our community, today and into the future," he added.
The public battle between the two major institutions: One a health care provider and the other a health care insurer, dates back at least to May when it appeared that SPHP would no longer be in the network of providers that UHC lists in the region. Being in network greatly eases and lowers the cost for patients who use a given provider in a health plan.
Essentially, SPHP said that UHC wasn't adequately reimbursing its providers - the hospital, clinics and other facilities - for the services they provide.
UHC, like other insurers, has complained that the rising costs of health care to the providers is squeezing their bottom lines and causing rates to go up.
St. Peter's Health Partners is part of the Trinity Health system, a national Catholic hospital network. And like other hospitals in New York, all of which are non-profit, St. Peter's has said it need higher reimbursements in order to stay healthy financially and to meet their staffing and other needs.
It doesn't appear that people with UHC were turned away from treatment during the dispute. State law calls for a "cooling off" period which meant the insurer would continue to cover care through the end of August, even though the agreement had lapsed in mid-summer.
Additionally, current St. Peter's patients were entitled by law to ongoing treatment for up to 90 days after the provider leaves the network. Pregnant patients were entitled to receive treatment throughout their pregnancies and they could still get postpartum care.
SPHP operates the Burdett Birth Center at Samaritan Hospital in Troy. It had earlier been slated for closure as the SPHP said it was losing too much money there. But that sparked a public outcry - pregnant patients would have had to go across the Hudson River to Albany - and the center is still open.
UHC is one of the largest health insurers in the U.S., earning $215 billion in 2024, according to reports, far larger than many of the Capital Region-based insurance companies.
SPHP isn't the only major regional health care system to be in conflict with an insurer of late.
Earlier in the month, the Times Union reported that Albany Medical Center is suing CDPHP over payments the hospital said have been wrongly withheld. CDPHP contends that a new government-mandated wage index for hospital workers meant that health insurance costs had risen beyond what it could pay for.
This story was originally published October 18, 2024, 8:45 PM.
