Tag Archive | "Empire"

Empire BlueCross and Hospital Alliance at Impasse

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The quiet period that had been exercised between insurer Empire BlueCross BlueShield and the three hospitals of the East End Health Alliance expired in the past two weeks as negotiations between the two parties have reached an impasse.

The Alliance took the opportunity recently to post on its website a message that argues, repeatedly, “Empire puts profits over patients.”

For their part, Empire posted on its website on October 12 an update that claims the Alliance is seeking an increase in reimbursements that is “unnecessary and would result in an immediate jump in health care costs on Long Island.”

The insurance company — which represents more clients on the East End than any other provider — and the local hospitals, including Southampton Hospital. Eastern Long Island Hospital and Peconic Bay Medical Center, have been at odds since this past summer, when negotiations first broke down at the time the agreement between them expired, and patients with Empire coverage were no longer covered by the hospitals. Since then Empire has made some concessions, and certain senior patients and those living within certain local zip codes, who live beyond 30 miles from another participating Empire Hospital (ie. Brookhaven or Stony Brook) would be covered at the Alliance hospitals.

In a posting on their website, Empire claims one reason the sides have not reached an agreement is that the Alliance is demanding an increase of over 60 percent over a 21 month period, adding the reimbursement rate would be greater than the reimbursement given to other similar hospitals in the state. The company says it has offered the Alliance several proposals, including the most recent a multi-year agreement with a “substantial” rate increase and a one time payment allowing the hospitals to invest in programs and operational changes which, it claims, would make the hospitals more efficient.

The Alliance argues that its hospitals are “among the most cost effective in the state”

“But Empire pays us less than it costs to treat you and your family when you need us — and significantly less than every other managed care insurance company we deal with,” read a post on the Alliance website.

What happens next?

“We’ve put reasonable proposals in front of them,” said Craig Andrews, an Empire spokesperson. “We’ve left it in their court.”

 “Empire BlueCross BlueShield remains willing to agree to a new, multi-year contract with substantial increases for EEHA hospitals, despite the difficult economy we all face,” said the insurer. “But there is a point where reason, and the hospitals obligation to manage their operations more effectively, must become a priority. The cost of health care is everyone’s responsibility, including EEHA hospitals.”

Alliance and Empire Trade Proposals

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While the “period of silence” between the three East End hospitals and insurer Empire BlueCross BlueShield was extended this week, the two parties continue to negotiate a new contract, and as recently as Tuesday have exchanged proposals.
The members of the East End Health Alliance — including Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital — have been out of network since late August, when negotiations stalled and their contract expired. They have since returned to the table and, according to both sides, are making progress — albeit slowly.
“I can’t say we’ve made great strides,” said Paul Connor III, CEO and president of Eastern Long Island Hospital and spokesman for the Alliance. “But we continue to make small steps forward.”
Connor said Empire had made a presentation to the Alliance board last Thursday, and the Alliance responded with a proposal of their own late Tuesday.
“It was basically a modified proposal from what was given to us by Empire,” said Connor. Neither Connor nor Craig Andrews, spokesman for Empire, would comment on the nature of the offer.
The biggest issue, said Connor, was how the hospitals are reimbursed for services, and said the Alliance is seeking a pay parity comparable to what they have recently negotiated with other insurance providers.
“Our goal, broadly, is to get our hospitals to break even financially,” said Connor. “And achieving a fair reimbursement from other insurers is getting us there. If Empire would do that, we’d be able to meet our goals.”
In the meantime, the insurance company has struck an arrangement with East End doctors to keep them in-network. It was feared two weeks ago that the doctors with admitting privileges at the Alliance hospitals would have fallen out of network on September 29; but the agreement allows patients to maintain the same relationship with their physicians as prior to the lapsing of the hospitals’ contract.
Patients also are entitled to be reimbursed for emergency care, and if admitted to an Alliance hospital under emergency care would be covered.
Also, while out of network, the Alliance hospitals will not pursue collection if a patient’s out-of-network’s co-insurance financial obligation is greater than his or her usual co-insurance.
Both sides agreed this week there was no specific deadline for negotiations to conclude.
“We never have a deadline,” said Andrews, “and are working on behalf of all our members. The negotiations are always ongoing.”
“Our goal is to be part of the Empire network,” said Connor on Wednesday. “But we have our own financial concerns and until they are resolved we’ll remain out of network.”

Empire Warns Patients They May Have to Look Elsewhere

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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.”