Northwell Health and Fidelis Care are on track to end their contract July 15, a split the health system said will affect more than 240,000 patients across Medicaid, Medicare Advantage and Essential Plan coverage.
Fidelis, part of Centene, previously issued a termination notice to New Hyde Park, N.Y.-based Northwell, triggering a cooling-off period set to expire July 15. Absent an agreement, Northwell providers will be out of network with most Fidelis plans, including Medicaid, Essential Plan, Ambetter marketplace plans, and Wellcare By Fidelis Medicare Advantage plans, beginning July 16, with an extended transition window through Aug. 13 for members with continuity of care protections. Wellcare’s own Medicare members’ termination date was effective June 30, according to Fidelis’s website.
In a June op-ed shared with Becker’s, Northwell COO Kevin Beiner wrote that accepting Fidelis’s proposed terms “would force Northwell to make difficult choices. It would mean fewer nurses at the bedside, reductions in critical community programs, and cuts to essential services in areas like cancer treatment, cardiac care, and mental health.”
Mr. Beiner also said in the op-ed that Fidelis owes the health system more than $100 million in unpaid claims and has a 38% claims denial rate.
Fidelis, in a statement attributable to the company, said it has “attempted to engage Northwell in discussions to reach terms” that balance access, quality and affordability, and that Northwell “continues to seek rates that significantly exceed those paid to comparable providers.” The insurer said it remains open to reaching an agreement.
A person familiar with the matter said Northwell’s net cost to provide care is roughly 24% higher than other providers in the region, translating to about $120 million in incremental costs. The source also said Northwell’s urgent care pricing runs well above market and emergency department rates, and that Northwell has negotiated higher carve-out reimbursement rates than other network providers.
Northwell told Becker’s that its rates reflect the cost of delivering high-quality care in the New York market.
“We are a not-for-profit system — we don’t have shareholders to enrich. Every dollar goes back into patient care and community health. The question isn’t whether our rates are too high — it’s why a Fortune 25 company is refusing to pay what care actually costs,” Mr. Beiner said.
Both organizations have set up resources for affected members. Fidelis has a provider search tool and is directing members to state and local resources, depending on enrollment type. Northwell has a dedicated patient line and a web page outlining coverage options. Emergency care remains available to Fidelis members at all Northwell emergency departments regardless of network status, both organizations said.
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