21 hours ago
Nearly 20K cancer patients at NYC's Memorial Sloan Kettering at risk of losing critical care over insurance spat
Nearly 20,000 patients at Memorial Sloan Kettering could lose access to critical care because of a contract battle between the renowned cancer hospital and health insurance behemoth UnitedHealthcare.
The two sides have until the end of June to hash out a new deal over reimbursement rates — but are trading blame while patients, many in need of lifesaving care, anxiously wait to see if they will keep in-network treatment.
Patient Lee Kassler, of Plainview, Long Island, said he was in 'disbelief' and 'shocked' when he found out that he could lose care on July 1 if the Manhattan hospital and health insurance company don't reach an agreement by June 30.
'Full of anxiety, full of stress, saddened, angry, worried, just a whole host of emotions that I was faced with when I was diagnosed with cancer,' Kassler, who has had a rare, incurable gastric cancer since 2022, told The Post Friday.
The new grandfather, 61, said he goes to MSK with '110 percent' confidence, and couldn't imagine using another medical center for his 'life and death situation.'
MSK officials have been pushing for a higher reimbursement rate for services, claiming the current yearly increase of 1.6% over the last five years isn't on par with rising costs the hospital is facing.
'MSK has worked hard to reach a long-term agreement with UHC — one that reflects the real cost and value of our specialized cancer care,' the hospital said in a statement. 'UHC refused to agree to that.'
But UHC argued that the top-rated cancer treatment center is pushing a 35% spike in reimbursement rates over the next three years — which could cost the health insurance provider nearly $470 million.
Memorial Sloan Kettering says UnitedHealthcare needs to increase the reimbursement.
Christopher Sadowski
'Our top priority is to reach an agreement with MSK that is affordable for consumers and employers,' the company, which also covers Oxford plans, said in a statement to The Post.
'We have proposed meaningful rate increases that would continue to reimburse MSK at levels significantly higher than other National Cancer Institute-designated health systems in the New York City metro area.'
The company, whose CEO Brian Thompson was fatally shot by alleged gunman Luigi Mangione last year, has also publicly worked to make its case to consumers.
MSK chief medical officer Cardinale Smith, meanwhile, argued in an interview the proposal from the health insurer is not financially sustainable.
UnitedHealthcare claims MSK's demands are too high.
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'Bottom line is that there are thousands of patients who need our care and UHC is just not putting them first,' Smith said.
About 19,225 patients, including Kassler, could have treatment disrupted, hospital reps said.
Sloan Kettering has gotten into past contract fights with Anthem and Cigna before deals were reached.
Even if a new agreement with UHC isn't inked by June 30, a New York state law requires a cooling-off period in which at least some patients will get in-network care at the hospital through the end of August.
The grace period applies to patients with fully insured UnitedHealthcare or Oxford plans for hospital care, both MSK and the health insurer said.
Patients can also apply for continuity of care that would possibly give them a temporary extension of in-network treatment.
With his birthday coming up in a few days, Kassler said all he wants is to receive news of a deal.
'The best birthday present was my grandson but the second best would be let's put this behind us,' Kassler said.
'Let me just be under the treatment of Sloan for a long time.'
