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Prime Healthcare's New Jersey Hospitals Announce Termination of Contract with UnitedHealthcare

  • Category: News
  • Posted On:
  • Written By: Saint Michael's Press Office
Prime Healthcare's New Jersey Hospitals Announce Termination of Contract with UnitedHealthcare

Prime Healthcare’s New Jersey hospitals announced they would terminate their contracts with UnitedHealthcare, citing significant underpayment compared to the rates of neighboring facilities.

The decision impacts Saint Clare’s Health in Denville, Dover and Boonton, Saint Michael’s Medical Center in Newark, and Saint Mary’s General Hospital in Passaic.

“We have been significantly underpaid for years by UnitedHealthcare, including some rates well below Medicaid," said Sonia Mehta, MD, regional CEO and chief medical officer of Prime Healthcare New Jersey. "United’s contract proposal is not reasonable and jeopardizes our ability to continue to deliver the quality care that our patients deserve.”

Due to new disclosure requirements by CMS, all hospitals must now disclose their contracted rates and Prime Healthcare learned that it had been significantly underpaid compared to what United has been paying neighboring hospitals.

The New Jersey Hospital Association (NJHA) has reported that Prime Healthcare hospitals provide quality healthcare services and that its cost of care is among the lowest in the State of New Jersey. 

“We are patient-focused and are committed to delivering the most compassionate care by exceptional physicians using state-of-the-art technology," Dr. Mehta said. "Undercutting our payments is unacceptable, and so we are taking the necessary step of providing notice of our intent to provide care out-of-network. We realize it is a bold move, but a necessary one to separate our hospitals from organizations that work contrary to our mission and commitment to our patients."

Prime Healthcare's New Jersey hospitals will continue to honor the rates and services in the agreements until the end of the cooling off period, which is December 16, 2021 for the Medicaid product and December 31, 2021 for the commercial and Medicare products.

All patients can continue to rely on the Prime Healthcare New Jersey hospitals for emergency services, regardless of insurance, and the hospitals are willing to negotiate single patient agreements for elective services. The hospitals will also honor all continuity of care services for United members.

About Prime Healthcare New Jersey

Prime Healthcare New Jersey, part of Prime Healthcare, is a network of acute care, community hospitals including Saint Clare’s Health in Denville, Dover and Boonton, St. Mary’s General Hospital in Passaic, and Saint Michael’s Medical Center in Newark.
Prime Healthcare is an award-winning health system operating 45 hospitals and more than 300 outpatient locations in 14 states. Prime Healthcare has received “15 Top Health Systems” recognition from Fortune/IBM Watson Health three times and its hospitals have been recognized among the “100 Top Hospitals” in the nation 58 times. For more information, please visit www.primehealthcare.com.