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Alliance and Empire Trade Proposals

Posted on 09 October 2009

While the “period of silence” between the three East End hospitals and insurer Empire BlueCross BlueShield was extended this week, the two parties continue to negotiate a new contract, and as recently as Tuesday have exchanged proposals.
The members of the East End Health Alliance — including Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital — have been out of network since late August, when negotiations stalled and their contract expired. They have since returned to the table and, according to both sides, are making progress — albeit slowly.
“I can’t say we’ve made great strides,” said Paul Connor III, CEO and president of Eastern Long Island Hospital and spokesman for the Alliance. “But we continue to make small steps forward.”
Connor said Empire had made a presentation to the Alliance board last Thursday, and the Alliance responded with a proposal of their own late Tuesday.
“It was basically a modified proposal from what was given to us by Empire,” said Connor. Neither Connor nor Craig Andrews, spokesman for Empire, would comment on the nature of the offer.
The biggest issue, said Connor, was how the hospitals are reimbursed for services, and said the Alliance is seeking a pay parity comparable to what they have recently negotiated with other insurance providers.
“Our goal, broadly, is to get our hospitals to break even financially,” said Connor. “And achieving a fair reimbursement from other insurers is getting us there. If Empire would do that, we’d be able to meet our goals.”
In the meantime, the insurance company has struck an arrangement with East End doctors to keep them in-network. It was feared two weeks ago that the doctors with admitting privileges at the Alliance hospitals would have fallen out of network on September 29; but the agreement allows patients to maintain the same relationship with their physicians as prior to the lapsing of the hospitals’ contract.
Patients also are entitled to be reimbursed for emergency care, and if admitted to an Alliance hospital under emergency care would be covered.
Also, while out of network, the Alliance hospitals will not pursue collection if a patient’s out-of-network’s co-insurance financial obligation is greater than his or her usual co-insurance.
Both sides agreed this week there was no specific deadline for negotiations to conclude.
“We never have a deadline,” said Andrews, “and are working on behalf of all our members. The negotiations are always ongoing.”
“Our goal is to be part of the Empire network,” said Connor on Wednesday. “But we have our own financial concerns and until they are resolved we’ll remain out of network.”

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