By Brenda Goodman, CNN

(CNN) — Tuesday morning, the nation’s largest insurance company, UnitedHealthcare and Memorial Sloan Kettering Cancer Center announced they had reached a multi-year agreement that will allow some 19,000 UnitedHealthcare and Oxford health plan customers to remain in-network for their cancer care.

The insurer and cancer center had been locked in a tense contract dispute. Negotiations went past a June 30 deadline, leaving many patients scrambling to find alternative coverage or care options.

One of them was Marla Puccetti, who said she spent all day Monday on the phone, urgently trying to reach someone at her health insurance company and the hospital that’s treating her cancer.

“I’ve been on hold all day long, basically,” said Puccetti, 53, who co-owns a restaurant with her partner in Narrowsburg, New York.

Puccetti doesn’t have out-of-network coverage on her current plan, so she would have had to pay the full cost of her care, which she can’t afford. But going anywhere but MSK for her treatment seemed unthinkable.

“It’s terrifying. I don’t want to go anywhere else,” she said. “All of my doctors are there. All of my surgeons are there. I feel like they saved my life.”

‘It all came as a shock’

The insurer and the cancer center, which has locations in New York City, New York state and New Jersey, had been in tense contract negotiations over rate increases that MSK said it needed to keep up with the cost of care.

UnitedHealthcare said MSK asked for a 30% increase in payments for its facilities and physicians, as well as a 36% increase for its cancer center. The insurer said the increases would drive up costs for consumers by $405 million over the next two years.

The insurer and cancer center didn’t announce the final terms of the new contract.

“We understand how difficult and deeply personal this negotiation has been for people and their families,” Junior Harewood, UnitedHealthcare CEO, New York, said. “We are pleased to renew our relationship and provide continued access to MSK for the people who rely on them for quality cancer care.”

The insurer had said it already reimburses MSK at rates significantly higher than other systems specializing in cancer care in the region.

Dr. Cardinale Smith, chief medical officer for MSK, disputed the idea that the cancer center is driving up the cost of care for patients. She said Monday its cost of care is actually 4% to 16% lower than at comparable hospitals in the area.

“Our patients are getting better outcomes for total lower cost of care,” Smith said.

UnitedHealthcare is the nation’s largest insurer, and Smith said hers isn’t the only system that was being squeezed in contract negotiations with them.

“This is happening in other institutions as well, and it reflects what I think is a deeper tension in our health care system where there are financial priorities that are really being placed ahead of what’s best for patients,” Smith said.

Puccetti, the MSK patient, was diagnosed with breast and then cervical cancer just a few weeks apart in 2021. After a mastectomy and a hysterectomy, her breast cancer is in remission, but her cervical cancer has been tougher to snuff out. It has returned three times. She has tallied 60 rounds of radiation and 100 rounds of chemotherapy and has lost her hair three times.

Her tumor is in a bad spot, she says, attached to both her bladder and her bowel. Doctors said they could remove it surgically, but it would leave her dependent on bags hanging outside her body to collect urine and stool for the rest of her life, a situation she found untenable.

Now, she’s on an immunotherapy drug that helps her body recognize and attack the cancer, with a goal of keeping it stable. She has been making the two-hour trip from her home in upstate New York to MSK about once a week for the past few months for tests to help doctors keep tabs on the tumor.

She got a letter just two weeks ago from UnitedHealthcare that said MSK might not be in her network starting July 1.

“It all came as a shock that this was actually happening,” she said Monday.

Patients caught in the middle

Until Tuesday’s announcement of a new agreement, thousands of patients had been left uncertain about whether they would be able to afford to continue their care at MSK.

Puccetti said she was researching other coverage options. Her UnitedHealthcare plan costs $3,200 a month and provides some coverage, but she still owes “thousands and thousands” in out-of-pocket costs.

Through it all, she’s worked full-time at the restaurant, cooking, tending bar, keeping the books.

She applied for financial aid through Memorial Sloan Kettering but hasn’t heard whether she qualifies.

“Everyone kept saying, ‘well, don’t panic, because they’re going to come to a resolution.’ So I tried not to panic, but how can you not?” she said.

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