With only 11 days left before Empire Blue Cross Blue Shield’s contract with several area hospitals expires, The East End Health Alliance, a partnership between Southampton Hospital, Eastern Long Island Hospital in Greenport, and Peconic Bay Medical Center in Riverhead, is scrambling to return to the negotiating table. Congressman Tim Bishop, a Southampton native, intervening on behalf of the alliance held a press conference at the Southampton Hospital’s Parrish Memorial Hall this Monday, July 20 urging Empire BCBS to return to the negotiating table to renew the contract before the July 31 deadline.
“I don’t want to be melodramatic and suggest that we are on the verge of a health care crisis,” said Congressman Bishop, “but we are certainly on the verge of a tremendously adverse situation that affects public health on eastern Long Island.”
This situation should not be unfamiliar to many local residents, as this isn’t the first time the East End Health Alliance has run up against insurance companies. In May of 2008 with Oxford Health Insurance and then once again in September of 2008 with GHI/HIP, the Alliance both faced stern opposition at the negotiating table. In both of those cases the Alliance was able to successfully negotiate new contracts.
Empire BCBS is much different than Oxford Health Insurance and GHI/HIP in terms of scope. Empire BCBS is Eastern Long Island’s largest health care provider, covering over 40% of all policy holders in the area. Many of these policy holders receive their Empire BCBS coverage from public schools and municipal jobs. The Alliance claims that they cover over 300,000 residents between the three of them, and if 40% of that number could no longer be covered by their insurance plan when they are admitted to those hospitals it would be, said Bishop, “intolerable and suggests that patient well-being is a secondary concern to [Empire BCBS’s] bottom line.”
Andrew J, Mitchell, President and CEO of Peconic Bay Medical Center said, “There are so many different varieties of health plans within the Empire BCBS product line, that it would be very difficult to estimate the number of people” that would be unable to come to Alliance hospitals due to insurance problems. Mitchell added that without adequate reimbursement from the insurance companies, Alliance hospitals could not provide the same scope of services that they currently do provide.
“[Current negotiations] are really going nowhere,” said Paul Connor III, President of Eastern Long Island Hospital and spokesperson for the East End Health Alliance. Connor was impressed with Congressman Bishop’s interest in the issue. “Tim [Bishop] is a tremendous advocate for our hospitals and health care,” said Connor.
Bishop used the platform to reiterate his support for a government alternative to the current health care system. “This is exhibit A on why we need comprehensive health care reform,” said Bishop.
If the contract expires before a settlement can be made many local area Empire BCBS policy holders could be redirected to hospitals in Patchogue or Port Jefferson, or be required to pay “more expensive out-of-network rates.”
Even if the two sides fail to come to some sort of agreement before the July 21 deadline, New York State law mandates that all emergency patients or pregnant women in their first trimester be admitted to a hospital regardless of their insurance status. Also only Alliance hospitals will be affected and personal doctors will remain unaffected.
“I believe this status results from Empire’s failure to negotiate in good faith,” wrote the congressman in a letter addressed to Mark Wagar, president and CEO of Empire BCBS and Angela F. Braly, president and CEO of WellPoint. The letter, written directly after the press conference, stated that the Alliance hospitals are asking for reimbursement rates similar to ones they have with other insurance providers. Similarly, according to the letter, the rates proposed by Empire BCBS would result in a loss of $500 per day by hospitals.
“No reasonable person can think that this is sustainable, no reasonable person can describe Empire BCBS’s posture here as negotiating in good faith,” said Bishop at the press conference.
George D. Keckeisen, MD, president of the Southampton Hospital Medical Staff, said, “This is a problem that needs to be addressed…and we hope that with the pressure we can bring to bear from the both health care provides, both the physicians community and nurses, in addition and in conjunction with the hospitals administration…that the Blue Cross provider will actually come to the table and make a realistic proposal that we can all live with.”
Bishop’s strongly worded letter concluded with the congressman saying that he might request a federal investigation of unfair practices in the negotiations if Empire BCBS does not capitulate to what Bishop believes are more reasonable rates.
Top: Congressman Tim Bishop with Paul Connor III, spokesman for the East End Health Alliance, at Monday’s press conference.
Inset: Bruce LaValle, R.N., speaking with Jasmine Dozier, R.N. (left) and Diane Groneman, R.N. (right).