Empire and Health Alliance Near a Resolution

Posted on 05 February 2010

By Bryan Boyhan

After months of grim news — or no news — there is a tone of optimism in the voices of those in the middle of the negotiations between the three East End hospitals and the region’s largest insurer, Empire BlueCross BlueShield. Since this past summer the sides have been at impasse, struggling mostly over the cost of reimbursement the insurance company would pay the hospitals of the East End Health Alliance, including Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital.

The impasse has put those hospitals out of the Empire network and, except for emergency care and a handful of other provisions, has forced Empire-insured patients to hospitals further west — such as Brookhaven Memorial and Stony Brook University — if they want to be covered by insurance.

“We’re very optimistic,” said Empire BlueShield BlueCross director of public relations Sally Kweskin, yesterday. “We’re keeping on track with negotiations.”

This is good news for the Empire-insured, since much of the talk over the past few months has been that the two sides were far apart and it was increasingly unlikely that negotiations would be successful.

“We’re looking to have some resolution in about two weeks,” said Kweskin.

“There are still some fundamental issues,” she said, “but we have made some progress on outside issues.”

The Alliance would agree.

“For the past couple of weeks we’ve made more progress on key issues than we have in the past five months,” said Paul Connor, president of Eastern Long Island Hospital and spokesperson for the Alliance.

He added, however: “I need to be cautious here. There is still work to do.”

Connor was hesitant to put a time frame on the negotiations, and said working out reimbursement schedules was “a fairly complex process.”

“There are all different types of rates,” he said.

Connor said there was no particular turning point that seemed to allow negotiations to open up.

“As time went by, we found more things we could compromise on,” he said.

He also credited Congressman Tim Bishop for helping to keep the two sides focused and moving forward.

“He’s been working very much in the background,” said Connor. “We’ve had a lot of help with this.”

At present, Empire-insured patients have full access to their doctors, but only limited access to the local hospitals. If admitted under emergency status, patients would enjoy the benefits of their prescribed coverage. But for scheduled procedures, they would need to go to an in-network hospital in order to get insurance benefits. The exception to this under certain plans would be if the patient lived beyond thirty miles of an in-network hospital.

Patients who are receiving benefits at one of the three member hospitals will be reimbursed directly by Empire. Those checks must then be signed over to the hospital as payment for the service.

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One Response to “Empire and Health Alliance Near a Resolution”

  1. Art says:

    It’s out of control! My health insurance is putting me in the poor house and I have to fight with them to cover anything. I wish the knuckleheads in Washington would stop thinking like Democrats or Republicans and start thinking like human beings. Maybe then we can get this crime syndicate under control. While they are at it maybe they can go after the archaic laws and dirt bag lawyers who excessively abuse the law to make a buck on the backs of honest and hard working doctors. They also contribute mightily to this health care nightmare. Until than please don’t get sick or hurt and oh yeah, have a nice day.

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