Oxford/United and JFK Medical Centers

 This is a broker notice from Untied Health, dated August 15

JFK Medical Centers Participation with the
 UnitedHealthcare and Oxford Networks

We are committed to providing your clients and their employees with access to comprehensive and affordable health care services. As part of this strategy, we are currently negotiating new contracts for all lines of business with JFK Medical Center, a hospital located in Edison, New Jersey.
 
We are employing good faith efforts to reach a new agreement with JFK Medical Center prior to the official termination date of September 15, 2011 that is acceptable to both parties and meets our commitment to keep health care affordable. If our current agreement with JFK Medical Center ends, it will affect all commercial products Oxford and UnitedHealthcare, as well as Medicare.
 
In the event of a contract termination, the state of New Jersey requires insurance carriers and hospitals to extend a four-month cooling off period to HMO clients. The cooling off period is a period of time after the termination of a contract, when HMO members can still access the terminated hospital on an in-network basis with the intention that the hospital and the carrier can reach a new agreement.
 
Since this cooling off period does not apply to non-HMO employer groups and members, in the event of a termination, JFK Medical Center would become non-participating for those members on September 15, 2011. For HMO employers and members, JFK Medical Center would become non-participating on January 15, 2012. Physicians without admitting privileges somewhere other than JFK Medical Center would also become non-participating on January 15, 2012 for all lines of business.
 
When speaking to your clients, please keep in mind the following points:
  • In accordance with state law, we will have Transitional Care guidelines in place so members who have scheduled or ongoing medical treatments at JFK Medical Center will continue to get care as appropriate.

  • Non-HMO members have access to JFK Medical Center on an in-network basis through September 14, 2011. HMO and Medicare members would continue to have access to JFK Medical Center on an in-network basis through the New Jersey cooling off period, which would end January 15, 2012 (coverage through January 14).
  • All members, regardless of product offering, who have a physician with admitting privileges only at JFK Medical Center, would continue to have access to that physician on an in-network basis through the New Jersey cooling off period, the last day of coverage would be January 14, 2012. However, if a physician schedules a member for services at JFK Medical Center after September 14, 2011 for non-HMO members and on or after January 15, 2012 for HMO and Medicare members, the member may be subject to higher out-of-pocket costs. (Note: Qualifying fully insured commercial members may have additional Transitional Care/Continuity of Care.)
     
  •  After September 14, 2011, a primary care physician or specialist should not refer non-HMO members to JFK Medical Center for any treatment or test. Instead, members should be referred to one of the major neighboring hospitals in our network, as listed below.
 
Neighboring Hospitals in Middlesex County
Saint Peter’s University Hospital
Robert Wood Johnson University Hospital
Raritan Bay Medical Center

 
We are sending communications to your non-HMO clients and members who may be affected by the JFK Medical Center termination from our networks. To view samples of these communications please click on the links below.
 
UnitedHealthcare Employer Letter
UnitedHealthcare Member Letter
Oxford Employer Letter
Oxford Member Letter
 
We will continue to work toward a positive outcome of affordable health care for our employers and their employees and will keep you informed about the status of the negotiations. If you would like more information or have questions, please contact your sales representative.