NJ Medical Group Optum To Go Out Of Network With Many Insurance Companies Next Month

Moses Goldstein, 64, has a pacemaker and has been seeing the same cardiologist in Hudson County for five years.

But during his visit this week, he was told he can't see her any longer, since the medical group Optum is going out of network with a slew of insurance companies in New Jersey next month. (Their revised list is below.)

"I'm not sleeping," Goldstein said in a phone interview with Patch on Monday. "I asked what to do now, and nobody can tell me 100 percent...if I had to pay a larger copay, okay, I have to swallow it. But to stop taking my insurance at all?"

On the heels of recently announcing that it would lay off 500 doctors and health workers and close dozens of New Jersey medical offices by the end of this year, Optum — a UnitedHealth company — said that next month, their remaining offices will go out of network with certain Medicaid, Medicare, and other plans in January of 2026.

Patients like Goldstein must find new doctors, a process that can be frustrating when they've learned to trust their specialist.

Goldstein said he doesn't want to switch insurances because some of his family members still have providers who are participating.

List Of Insurances

Optum doctors and medical practices in New Jersey will go out of network with the insurance plans on various dates in January — some on New Year's Day, others on the 15th and some on the 30th.

In a statement given to Patch, Optum said, "[Optum] has made updates to our Medicaid and Medicare payer relationships in New York and New Jersey as part of our ongoing commitment to delivering long-term, affordable care for the communities we serve.... Patients who wish to keep their trusted Optum provider can select from a wide range of in-network plans that can be reviewed here."

A spokesperson confirmed on Tuesday that the following is the most up-to-date list of insurers that will go out of network in January:

• AmeriHealth commercial plans: Effective Jan. 15
• Cigna/HealthSpring Medicare Advantage: Effective Jan. 31
• All Fidelis plans, including:
  • Commercial-NJ: Effective Jan. 1
  • Managed Medicaid-NJ: Effective Jan. 1
• Horizon (Blue Cross)
  • Dual Special Needs (DSNP): Effective Jan. 15
  • Managed Medicaid: Effective Jan. 15
• Wellpoint (AmeriGroup)
  • Medicare Advantage: Effective Jan. 31
  • Managed Medicaid-NJ: Effective Jan. 31

The Advantage plans are typically used by seniors on Medicare to expand their range of providers.

The full list of affected plans is here. Double check to see if your plan is on it.

'Leaves Patients In A Vulnerable State'

Patients were shocked last month to get 30 days' notice that they'd lose their psychologists, pediatricians, and more.

The announcement of the insurance changes, coupled with the closure of most services at a hospital in North Jersey, gave area patients even fewer options.

Carrie Hodge, a physician's assistant who helped found Dimer Health in North Jersey — a virtual medical practice that takes insurance — said what's happening with New Jersey health care systems is "disruptive," noting that there could be long-term health effects.

"When access to care like this changes rapidly for people, for both Medicaid and Medicare recipients — some of the most vulnerable — this type of disruption leaves patients in a much more vulnerable state," she said in an interview.

She added that when care is disrupted, "What that leads to is more disease exacerbation, untreated symptoms. That, to me, is the tragedy of all of this. People are going to be left foundering."

A Patch reader agreed in the comments section of a recent Optum story, noting, "We need the behavioral health! I’ve had the same doctor for nearly a decade and my children have been seeing theirs for years. You are leaving some of the most vulnerable people in this city in the dust."

Hodge said that as a breast cancer survivor, she knows the importance of consistent care.

"Optum is closing a lot of their specialty offices, and one of them is behavioral health," she said. "These are people with specialized conditions being managed....When you're dealing with something that difficult, trying to navigate our complex health care environment can be extremely overwhelming and exhausting."

She said that government support of Medicaid and Medicare can impact whether a company takes those insurances, noting that reimbursement rates may be lower than for private insurances, causing companies like Optum to drop the programs.

UnitedHealth Group's CEO was quoted as telling investors in a conference call in late October, "To be constructive, sometimes you have to take some things away."

BEven with the financial constraints that providers face, Hodge said it doesn't make sense for patients to have to struggle to get health care anywhere, in modern times, when other services are at their fingertips.

"We're in a time when technology has evolved, access to care shouldn't be an issue anymore," she said. "Amazon can get you a package overnight, but we can't get people basic healthcare."

Read More

• Optum To Restore 2 Pediatricians In One NJ City After Outcry
• Patients React After Optum Closes Dozens Of Medical Offices In NJ
• Major Healthcare Provider Closes Medical Offices In NJ
• Optum To Lay Off 572 Doctors, Others Statewide

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