United Healthcare and Oxford Health Contract Expirations

Answer: If you have specific questions or would like additional information, please call our dedicated United/Oxford contract hotline at (631) 638-4013.

Answer: The current contracts between United/Oxford and the hospitals and physician practices of Stony Brook Medicine expire at midnight on June 1, 2025. At that time, and unless continuing negotiations result in new contracts, these facilities and physician practice plans no longer will be participating providers (sometimes called “in network”) in the United and Oxford networks. IMPORTANT FOR EMPIRE PLAN/NYSHIP MEMBERS: These terminations do not affect your coverage. The Empire Plan is subject to separate contract agreements that are not expiring at this time.

Answer: United and Oxford are “for profit” national health plans that provide insurance and healthcare coverage to some residents of Suffolk County and the surrounding area for hospital inpatient and outpatient services, and for physician, medical, pharmacy and other healthcare services.

Answer: Stony Brook University Hospital, Stony Brook Southampton Hospital, Stony Brook Eastern Long Island Hospital, the Stony Brook Medicine Physician Practices listed at the end of this FAQs, the physician practices of Stony Brook Community Medical, and the Meeting House Lane Medical Practice. 

Answer: Representatives of Stony Brook Medicine continue to negotiate with United/Oxford to reach agreements on new contracts. If we are unsuccessful before the current contract expiration date then unless a United or Oxford member/patient has “out-of-network” benefits, United and Oxford  will cover only emergency services provided by Stony Brook Medicine on or after June 1, 2025 (or, in some cases, after August 1, 2025; please see the important information in Number 10 below).

Answer: You always will be able to receive emergency services at Stony Brook Medicine’s hospitals regardless of network participation. You should contact United, Oxford or your employer’s benefits office to determine what benefits are allowed under your specific United or Oxford health plan. If your United or Oxford health plan has an “out-of-network” benefit, you still may be able to use Stony Brook Medicine’s services. Patients who are admitted to Stony Brook Medicine’s hospitals before the contracts expire will be fully covered, as will hospital outpatients who have already started a continuing course of treatment. (Members in the hospital will remain covered until the date of a medically appropriate discharge. Members undergoing an outpatient or physician managed course of treatment will remain covered for up to 90 days. A member in the second trimester of pregnancy will be covered for a transitional period that includes postpartum care.)

Answer: In general, HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) contracts do not offer out-of-network benefits. Some United and Oxford health plan products offer varying degrees of out-of-network benefits. You should check with United, Oxford, your employer benefits office or your United/Oxford subscriber handbook to determine what benefits your plan product provides.

Answer: You should contact United, Oxford, or your employer’s benefits office to determine what benefits United or Oxford will allow. Stony Brook Medicine will continue to bill United or Oxford on your behalf but you may be responsible for some part of the bill. If this happens, please contact the Patient Accounts Department identified on any bill that you may receive to determine your eligibility, if any, for financial assistance and possible payment options. For hospital bills, based on your income and family size you may be eligible for a reduction of your bill under the hospitals’ Financial Assistance Program.

Answer: Yes. Physician contracts at Stony Brook Medicine also expire at midnight on June 1, 2025, and the doctors no longer will be United/Oxford “in-network” participating providers after that date. (Please note that the extra two month coverage period discussed in Question* below does NOT apply to physician services.) If your United or Oxford policy has an out-of-network benefit, you may continue to see your physician on an out-of-network basis. If your benefit for physician services is through another health plan, you may be able to continue to see your Stony Brook Medicine physician. (Please contact that plan to determine if your Stony Brook Medicine physician is “in network” with that plan.) If you do not have an out-of-network benefit, United or Oxford may expect you to find a new participating physician. Under certain clinical circumstances, you may be able to continue to be treated by your physician for up to ninety (90) days.

Please discuss the details of your plan with your health benefits office. If you have further questions, it is best to discuss them directly with United/Oxford. Please feel free to call us for the latest status regarding the negotiations at (631) 638-4013.

If you have an appointment with a Stony Brook Medicine physician or have been pre-authorized for a test or treatment at a Stony Brook Medicine hospital after June 1, 2025 (or for the hospitals, August 1, 2025, as per Question* below).

Answer: This is a decision you may want to discuss with your physician. Again, you should check to see if your United or Oxford health plan has an out-of-network benefit.

Answer: Many United and Oxford health plan products are regulated by a New York State law that adds two months to any expiration of a hospital contract. For members covered by these products, the law requires the terms of the United and Oxford hospital contracts (but not physician group agreements) to be honored through August 1, 2025.

Some United or Oxford members, however, may belong to health plans that are funded in whole or in part by contributions from the members and from their employers or labor unions, and United/Oxford pays claims out of the money contributed instead of United or Oxford’s own funds. Those “self-funded” plans are not subject to any extension, and for those members the terms of the United/Oxford contracts no longer will be in effect after June 1, 2025. Since this is important to know, United and Oxford members are encouraged to contact United/Oxford or their employer’s health benefits office to find out into which category their health plan falls.