What Consumers with United Insurance Receiving Care at Montefiore Facilities Need to Know

Which Montefiore facilities and their affiliated physicians are now out of network?

  • Montefiore Medical Center (Wakefield Campus, Westchester Square Campus, Moses Campus)
  • Montefiore Mount Vernon Hospital
  • Montefiore New Rochelle Hospital
  • Montefiore Nyack Hospital
  • Montefiore Weiler Hospital - Einstein Campus
  • Montefiore St. Luke’s Cornwall (Cornwall Campus and Newburgh Campus)
  • White Plains Hospital

Montefiore Burke Rehabilitation Hospital is NOT impacted and remains in-network.

When will Montefiore no longer be in network for UnitedHealthcare and Oxford?

The timing of when consumers will lose in-network coverage will depend on the type of plan they’re enrolled in:

Fully-insured large group, small group and individual health plans:

  • Montefiore physicians will be out-of-network, effective Jan. 1, 2021.
  • Montefiore hospitals will be out-of-network, effective March 1, 2021.

Employer-sponsored self-insured (ASO) coverage:

  • Montefiore physicians and hospitals will be out-of-network, effective Jan. 1, 2021.

Community Plan (Medicaid):

  • Montefiore physicians will be out-of-network, effective Jan. 1, 2021.
  • Montefiore hospitals will be out-of-network, effective March 1, 2021.

Medicare Advantage DSNP:

  • Montefiore’s hospitals and physicians will be out-of-network, effective April 1, 2021.

Medicare Advantage ISNP:

  • Montefiore physicians will be out-of-network, effective April 1, 2021.

Montefiore does not participate in United/Oxford’s network for people enrolled in standard Medicare Advantage plans, with the exception of Montefiore St. Luke’s Cornwall Hospital. United/Oxford’s contract with St. Luke’s for Medicare Advantage plans is not impacted.

New York law also provides that insureds who are in a on-going course of treatment with a health care provider (for example, a physician), or who are in the second trimester of pregnancy, may continue treatment for 90 days (or through delivery and related post-partum care for a pregnancy) from when they were notified that the provider will be out-of-network if the provider agrees to accept the insurer’s in-network rate. The 90-day period for Montefiore ends on April 1, 2021.         

What if I need emergency care?

Insurers must cover emergency services provided in a hospital, regardless of whether the hospital participates in the insurer’s network, and the insured is only responsible for the in-network cost-sharing. UnitedHealthcare/Oxford insureds will have access to the Montefiore hospitals for emergency services.    

What if I’m currently getting care at Montefiore?

You should contact United/Oxford at the number on the back of your ID card to see if you qualify for continuing coverage. New York law provides for a 90-day transitional period (runs concurrently with the 60-day cooling-off period which started January 1, 2021) for patients in an on-going course of treatment (for example, cancer) or their second trimester of pregnancy to continue to with their current health care provider when that provider leaves that network. The provider must agree to accept the in-network rate as payment in full during the transitional period.

How do I find a new hospital or provider?

Use the 800 number on the back of your ID card to speak to the right team at United. They should have trained staff who can help answer your questions and assist you finding new in-network doctors or hospitals in your area.

How do I find out more information from either United/Oxford or Montefiore?

Both UnitedHealthcare/Oxford and Montefiore have provided notices to the impacted insureds. United and Montefiore also have websites with information about the termination of their contract: