As many of you may already know, effective January 1, 2022, the New York State Health Insurance Plan (“NYSHIP” or the “Empire Plan”), acting through its administrator UnitedHealthcare, Inc. (“United”), dramatically and improperly reduced the rate at which the Empire Plan reimburses out-of-network physician services. United is wrongfully slashing those rates – generally from 80% of usual and customary charges to a rate about 15% of what is otherwise required – under the guise that it has authority to do so under the federal No Surprises Act. The impact of these unilateral and unlawful actions will be staggering on the reimbursement rates for out-of-network providers and will also, as a consequence, have a devastating impact on the availability of out-of-network providers to care for United’s members.
Consistent with its decades-long history and mission of serving the healthcare industry, Garfunkel Wild P.C. (“GW”) immediately stepped into the fray to challenge the actions of United. Recognizing that the resolution of this dispute may involve a political process, and with the endorsement of the Medical Society of the State of New York (“MSSNY”) that represents over 20,000 New York State licensed physicians, GW wrote to Governor Hochul to encourage her to take steps to compel United to comply with the existing terms of reimbursement that were negotiated and agreed to by NYSHIP’s unions. Click here to view the letter. MSSNY, which has also been active in challenging United, likewise sent a letter on behalf of its members. Click here to view the letter. We are informed that discussions are currently taking place between the Governor’s Office and the unions concerning these and related issues.
While that process plays out, GW will use the time to craft a legal challenge to United’s actions should such a legal challenge prove necessary. While some may be anxious to bring immediate legal action, GW believes that such immediate action may not be the best path for a positive outcome. Particularly given that the New York State government, including the Governor’s office, is in the midst of budget negotiations, GW believes that the parties need to let this process ripen without the potentially counterproductive pressure of an immediate lawsuit. Indeed, starting a lawsuit so quickly after sending a letter designed to inform the political process could be seen as bad faith. Moreover, any immediate legal challenge may be rendered moot by the outcome of that process. Further supporting of the notion of proceeding smartly and cautiously is the reality that an immediate lawsuit will not provide an overnight remedy to United’s wrongful actions, but will likely take years.
Consequently, GW, with the endorsement of MSSNY, is striking a different course, one that is aggressive, yet sensible, calculated and cost-effective. GW will use this brief interlude to develop a comprehensive and sustainable legal challenge to United’s action in order to enhance the litigation’s chances of success, should litigation prove necessary. Toward that end, GW has been forming a coalition of providers and other stakeholders who are interested in joining this effort, a coalition that has been increasing steadily in size with each passing day.
If you are interested in joining this coalition, please contact the Garfunkel Wild attorney with whom you regularly work, or any member of the GW/United Committee: Andrew Blustein at [email protected]; Debra Silverman at [email protected]; John Martin at [email protected] or Andrew Zwerling at [email protected]. We will then forward you the necessary logistical information to join.