Stony Brook Medicine Doctors Warn Patients About Looming Expiration of Contract With UnitedHealthcare and Oxford

South Fork doctors have begun warning their patients with UnitedHealthcare and Oxford insurance plans that the carrier’s contract with the Stony Brook Medicine network and Stony Brook Southampton Hospital is due to expire at the end of this month.

If a new contract is not resolved by June 1, those patients may no longer be covered at network medical offices or for nonemergency procedures at the hospital.

A Stony Brook Medicine spokesperson said that the network is still in negotiations with UnitedHealthcare and hopes to resolve the standoff before the current contract expires.

“Stony Brook Medicine is focused on providing comprehensive, high-quality and affordable health care for patients,” the statement from Stony Brook Medicine said. “We continue to work diligently with UnitedHealthcare toward a mutually beneficial settlement and are optimistic that we will come to terms. We are committed to assisting patients, and keeping them informed, during this process.”

But the network has warned patients to be prepared for a lapse in coverage at some facilities and has set up hotlines for patients.

“The network contracts between UnitedHealthcare/Oxford Health and Stony Brook Medicine expire at midnight on June 1, 2025,” one of the letters sent to patients by doctors in medical groups in the network read. “Unless the contracts are renewed before then, your care at one of our hospitals, physician practices and ancillary care center may not be covered by your current plan.”

The Stony Brook Medicine hotline specifically for matters related to UnitedHealthcare and Oxford plans is 631-638-4013.

If the contracts are not renewed by June 1, it would mean that elective surgeries and nonemergency procedures at Stony Brook Southampton Hospital and doctors visits to any of the physicians in the network would no longer be covered. The hospital would still accept patients to its Emergency Department regardless of insurance status.

Negotiations between health care networks and insurance companies can frequently be a matter of brinkmanship, as both sides have financial bottom lines in mind and few options for how they can be reached, experts in the field say.

“This goes on all the time, and it always comes down to the 11th hour,” Anthony Cardona, president of Cardona & Company, an independent insurance broker based in Sag Harbor, said.

“Hospitals get paid three ways: Medicare, Medicaid and private insurance. Medicare, they break even; Medicaid, they lose money, 75 cents on the dollar. So they need to make as much money as they can from private insurance to stay in business.

“So you get this tug of war — the hospitals trying to get the most they can, and the insurance companies fighting it to limit what they have to pay,” he said. “It’s a bad look for both.”

The national struggle with the cost of health care and health insurance has reached boiling points in the past. The CEO of UnitedHealthcare, Brian Thompson, was murdered by an assassin in December in New York City — a crime that sparked macabre celebrations on social media laced with vituperative denouncements of the health insurance industry as a whole.

Health insurance companies are highly regulated by the government and can only show profits of roughly 15 percent, so they set their premiums to maximize that, based on what they can show they can reasonably expect to have to pay out for care the following year.

The tug of war Cardona refers to is increasing in intensity, as more and more small health care providers join the large network umbrellas like Stony Brook, Northwell Health and NYU Langone, to improve their bargaining position for what the insurance companies will pay for procedures. Meanwhile, the number of insurance companies dwindles, leaving patients with fewer and fewer choices.

If Stony Brook Medicine, which controls two of the three hospitals and the largest network of doctors on the East End, were not to reach a new contract with UnitedHealthcare, many, if not most, local residents would be forced to seek another provider — an undoubtedly more expensive one.

“For small groups, under 100 employees, there are really only, like, three carriers left,” Cardona said. “So if Oxford concedes here and says, ‘Stony Brook, you’re the biggest operation on the East End — we’ll pay you whatever you want,’ that’s just going to raise your rates.”

“The system is 100 percent broken,” Cardona said. “I don’t care if you voted for Trump or Bernie or Santa Claus — nobody is going to be able to lower the cost of insurance until you lower the cost of health care.”