Healthcare cost and policy

32BJ, NewYork-Presbyterian, and the cost of excluding a health system

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Tough day for the sales rep.

New York’s 32BJ excluded New York-Presbyterian from their health plan a few years ago in an effort to control costs.

This year, the union tried to switch to Aetna for its 175,000 participants, but New York-Presbyterian (NYP) blew up the deal, claiming that 32BJ still owed $25 million for previous care.

NYP required payment for this unsubstantiated claim to continue to be excluded from the network. The crazy thing is that New York-Presbyterian’s contract with Aetna put the hospital in the driver’s seat.

Contracts matter.

https://lnkd.in/eTWMvsnX

Originally posted on LinkedIn, where the discussion and source links live in the comments.

About the author

Chris Vanderwolk is Director of Compliance and Innovation at OneDigital | Kistler Tiffany Benefits General Agency, where he helps brokers and employers navigate the regulatory complexity of employee benefits. An ERISA attorney with more than 19 years in the benefits industry, he specializes in translating what the law actually requires into language people can use.

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