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Empire and Health Alliance Reach Agreement on Senior Care

Posted on 28 August 2009

East End Health Alliance on Long Island and Empire BlueCross BlueShield announced today that they have reached agreement for MediBlue members of Empire BlueCross BlueShield. Details are being finalized, but the multi-year agreement will assure seniors with Empire Medicare Advantage “Mediblue” HMO and PPO products can continue accessing services at the three East End Health Alliance Hospitals as “in-network.”

“We are pleased to have settled this important component of the Empire contract,” said Paul Connor, president and CEO of Eastern Long Island Hospital in Greenport, and spokesman for the East End Health Alliance. “It is important for our seniors in the East End with Empire plans be assured they are covered.”

“We are pleased to reach this agreement with the Alliance as a result of continuing negotiations,” noted Mark Wagar, president and CEO, Empire BlueCross BlueShield. “We are pleased that we reached an agreement that will ensure our senior members have convenient access to their community hospital.”

For all other Empire plan members, all Emergency care remains covered as In-Network. Some Empire members may be eligible to continue to receive routine, non-emergency services with full in-network benefits at these facilities if there is not an alternate facility within 30 miles of their residence.

The Alliance has not been participating in the Empire network since August 1, when . The Alliance Hospitals will continue to provide emergency care and elective medical services and, consistent with Alliance policies, no patient will be turned away who is in need of medical care.

The Alliance Hospitals announced the adoption of a policy, effective August 1, 2009, that is designed to financially assist patients who may incur greater financial costs due to Empire’s out-of-network policies. Under this policy, the Alliance Hospitals will not pursue collection of a patient’s out-of-network coinsurance obligation – to the extent it exceeds the patient’s in-network obligation under an Empire plan. The patient will remain responsible for his/her deductible. This policy applies to Empire members with commercial plans and to self-insured plans administered by Empire (which may include state, county and municipal employees, school districts and employers). This policy does not apply to the Empire Senior Plan members.

Under some Empire plans, patients will continue to receive in-network benefits if the patient lives more than 30 miles from a participating Empire hospital. Other Empire plans do not provide this benefit and the patient will be forced to use his/her out-of-network benefits.

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