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Empire Warns Patients They May Have to Look Elsewhere

Posted on 23 April 2008

With hundreds — if not thousands — of clients along the South Fork, Empire Blue Cross Blue Shield is currently negotiating its contract with Southampton Hospital. And while representatives from the hospital and the insurance company are both optimistic about a successful settlement, the company this week notified many of its clients they may have to find another hospital.

In a letter mailed to its subscribers this week, Empire said that the current contract with the hospital expired on March 31. State law and previous negotiations are allowing the contract to continue until the new contract has been successfully negotiated, or until May 31, which is when the extended contract period is slated to end. If that is the case, subscribers would need to receive their non-emergency hospital care at another facility, such as Peconic Bay Medical Center in Riverhead, Brookhaven Memorial Hospital or Stony Brook University Hospital.

“We certainly hope that a reasonable agreement on your behalf would be completed before May 31st,” read a portion of the letter. “Based on history, despite occasional news media coverage, actual terminations of hospital contracts rarely occur and have always been resolved within a relatively short period of time when they do terminate.”

In addition to many individuals and private employees, many municipal employees are also affected by the contract. Empire covers the Town of Southampton, and the Village of North Haven. In addition, the Sag Harbor Police Department is expected to go with Empire beginning June 1, and the Town of East Hampton has been debating leaving their current insurance carrier and switching to Empire.

At issue in the negotiations are a number of items, said Lisa Greiner, a spokesperson for Empire, including annual increases to cover hospital operating costs and costs of services.

“We are definitely committed to continuing our relationship with Southampton Hospital,” said Greiner, who added they are negotiating vigorously for the benefit of their customers.

Officials at Southampton Hospital are also optimistic that negotiations will be completed successfully, and spokesperson Marsha Kenny said that it was “business as usual.”

“They have been in discussions for some time,” she said. “I urge people not to get nervous. They are still covered, not to worry.”

“We are confident that we will come to a new contract,” said Kenny.

At present, despite the fact the original contract is expired, the full force of that contract will remain through May 31, or until a new contract is settled.

After that time, if there is no new contract, Empire Blue Cross Blue Shield customers may have to make some adjustments.

Under all scenarios, emergency coverage will be included at Southampton Hospital — or any hospital — for Empire customers. And if a patient is admitted under emergency status, he or she will be covered for their stay.

And if an Empire patient in Southampton Hospital prior to June 1 is still there after that date, transitional care will be provided for an additional 30 days, ending on June 30, providing the hospital agrees to provide care under the same terms as the recent contract.

After June 1, however, a patient seeking an elective procedure would need to go to another hospital if they expect to be covered in the Empire plan.

“You will no longer be in the network if it’s not an emergency,” said Karl Washwick, whose agency handles Empire Blue Cross Blue Shield.

Another issue would be the primary care or referring physician, who may only have rights at Southampton Hospital. The patient could choose another primary care physician, said Greiner, or if the patient wanted to continue to work with the doctor, he or she could be treated at the hospital, but would not enjoy the network rate.

“If a provider doesn’t have privileges at another hospital, he would get information on how to get credentialed at another facility,” said Greiner.

Despite the threat of severing the relationship, Washwick said he saw the negotiations as mere saber rattling.

“It’s never going to happen,” said Washwick. “Blue Cross is too big, and the fight is always about money.”

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