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Oxford Health Negotiating With Local Hospitals

Posted on 28 May 2008

East End residents who are subscribers to Oxford Health Insurance may soon find themselves looking for other hospitals. All three local hospitals, including Southampton, Peconic Bay in Riverhead and Eastern Long Island in Greenport, are currently negotiating with Oxford and its parent company, United Health Care, to maintain contracts for insurance. But their deadline is fast approaching. If an agreement is not reached by June 6, the hospitals will be “out of network” beginning June 7 for Oxford subscribers.

At issue is the rate in which the hospitals are being reimbursed for the care they provide.

“The three hospitals have been negotiating in good faith with the critical issue being fair and equitable reimbursements in order to provide for the essential healthcare of our communities,” said a release issued this week from the hospitals. “Our hospitals are being reimbursed at a rate that is far below other hospitals on Long Island even though our costs are comparable and employers are paying comparable amounts for health insurance premiums of their employees.”

Southampton Hospital just resolved a similar fight with Empire Blue Cross Blue Shield last month, narrowly avoiding a deadline that would have sent their subscribers looking for other hospitals.

“We are optimistic this will work out,” said Mary McElrath-Jones, spokesperson for Oxford/United Health Care.

“What we are offering them is in line with market trends,” said McElrath-Jones.

“We disagree,” said Paul Connor, President and CEO of Eastern Long Island Hospital who spokesman for the three East End facilities. “Obviously this is where we’re at.”

A specific comparison of rates could not be made, said Connor, since the rates themselves are protected by confidentiality. He did say that his hospital was told by the insurance company that they were paid at a rate below the Long Island average.

If no agreement is reached by the deadline, Oxford and United Health Care subscribers here will be faced with several options. Patients who are currently being treated for a specific condition at Southampton Hospital will continue to be treated and covered by the insurance company. But those who have scheduled a procedure after June 6, may need to make other arrangements as the treatment will not be considered in network. McElrath-Jones said, however, that patients may be entitled to transitional care and should contact the insurance company. In all cases, however, if a patient is admitted as an emergency, he or she will be treated and covered by the insurance company.

 

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One Response to “Oxford Health Negotiating With Local Hospitals”

  1. Mutie says:

    Hello, I’m not sure if I’m asking the right question or the right person. I am searching the internet for tips on negotiating higher in-network rates (for a provider) with carefirst. Is there anything you can tell me that would help. I understand I need to supply an excel report with procedurers existing rates and proposed new rates, along with justification. I am having problems with the justification.

    thank you


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