Empire Moves to Make Sure Local Docs Stay in Network

Posted on 10 September 2009

As negotiations between the three East End hospitals and the area’s largest insurer continue in silence, a spokesman for Empire BlueCross BlueShield confirmed this week that the company is arranging to keep local physicians in network, even while the local hospitals will not be.

Prior to this decision by Empire, local doctors who have admitting privileges to hospitals that are members of the East End Health Alliance — including Southampton, Eastern Long Island and Peconic Bay Medical Center — would have fallen out of network on September 29.

But a spokesperson from Empire confirmed yesterday that the insurance giant is working on a deal to keep the patients of those same physicians covered.

“We’re reaching out to the doctors now,” said Craig Andrews, media relations representative for Empire. “Members will be getting letters as well.”

The September 29 date falls 60 days after the hospitals’ contract with Empire was terminated, leaving patients on the East End with a choice of traveling further west on the island to an in-network hospital for such procedures as elective surgery, or going to a local hospital and be treated as an out-of-network patient. In response, the local hospitals, all agreed to waive certain fees in an effort to bring costs down. Patients admitted under emergency status, however, are still treated as in-network and enjoy the benefits of their specific plan.

Tentatively, and Andrews said details were still being worked out, the arrangement with physicians will allow them to remain in-network and care typically associated with a physician will still be covered based on an individual’s plan. In case of hospitalization, however, the patient would still be considered by Empire as out-of-network in an Alliance hospital. Andrews said Empire is working on an arrangement to allow local physicians to gain admitting privileges to other Long Island hospitals covered by Empire, including Stony Brook and Brookhaven.


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