Fidelis policyholders lose in-network coverage with Northwell Health

Northwell Health patients with insurance coverage through Fidelis will have to find new doctors, pay out-of-network costs or get new insurance after the two sides failed to reach an agreement on a new contract last week.

The change impacts about 200,000 people on Long Island and hundreds of thousands of people across the state, including those on Medicaid, low- and moderate-income people on the Essential plan and self-employed or small business owners on the Exchange plan.

Fidelis patients can still seek and receive emergency care at Northwell hospitals.

Fidelis did not respond to a request for comment, but recently told Newsday that Northwell "continues to seek rates that significantly exceed those paid to comparable providers." It is the leading insurer for Long Islanders who have Affordable Care Act policies, and the second-largest insurer of residents with Medicaid managed care and state Essential plan coverage.

People with established Managed Medicaid, Essential plan and Exchange (marketplace) coverage will be allowed to continue treatment with their Northwell providers through Aug. 13.

And policy holders who are pregnant will be able to stay with their Northwell doctors through delivery and postpartum care.

After that time, patients with "chronic medical needs" such as those associated with cancer and diabetes will "be supported" while either continuing care at Northwell, changing to an in-network doctor or finding a new health plan.

In a statement, Northwell said accepting the terms that Fidelis was offering would mean "fewer nurses at the bedside, reductions in critical community programs, and cuts to essential services in areas like cancer treatment, cardiac care, and mental health."

Insurance companies and healthcare systems around the region and the United States have been battling over costs and reimbursement rates. In May, Catholic Health went out of network for patients with Healthfirst insurance after they failed to reach a new agreement.

A tense stalemate between Anthem Blue Cross and Blue Shield of New York and the Mount Sinai Health System ended in April with a new contract.

Once Shari Bardash-Eivers, of Farmingdale, found out her Northwell doctors would no longer be covered by her Fidelis plan, she set out to change her insurance.

"They have no idea how difficult this is," said Bardash-Eivers, a small-business owner. "I spent hours on the phone."

First she was told she would have to wait for open enrollment at the end of the year. She called state agencies and elected officials, wrote letters and did research. She finally found someone who could change her insurance for her and will move to Healthfirst Aug. 1.

"Nobody told everybody," Bardash-Eivers said. "There is nobody to help 200,000 people through this and that's wrong."

Newsday's David Olson contributed to this story.

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.