Tag Archive | "Empire Blue Cross"

Deadline Passes, Hospitals Will Waive Some Fees for Empire Policy Holders

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By Andrew Rudansky

With the passing of the August negotiations deadline, the three member hospitals of the East End Health Alliance  — Southampton, Peconic Bay Medical Center and Eastern Long Island — are now no longer in the Empire Blue Cross Blue Shield network. But the Alliance has agreed to make it less painful, financially, for local residents insured by Empire.

The main point of contention in the negotiations is the rate at which Empire would reimburse the Alliance hospitals for services rendered to patients.

In response to passing the deadline the Alliance has adopted a new policy, waving any additional co-pay charges, for elective procedures, that Empire policy holders would incur for being “out-of-network.” Paul Connor III, President of Eastern Long Island Hospital and spokesperson for the East End Health Alliance said that the premise of this policy was to try to eliminate any of the costs that Empire puts on its members for using any outside facilities.

“Yes we could be losing money,” said Connors, “but we believe that it would be an advantage for the out-of-network holders if they could still use Alliance hospitals, that they are used to using.” Citing the “greater good” Connors believed that the policy would be “a gesture towards the community.”

In response to this news Hummel said, “We are very happy that they are concerned with the financial impact of these negations on their members.” Hummel added that she wished the Alliance had exhibited this same concern for their patients before the deadline passed on August 1.

Despite the passing of the deadline both sides are committed to continue the negotiation process.

Craig Andrews, Public Relations Director at Empire Blue Cross Shield said that Empire’s “goal has been to resolve this, it is our goal to get them back in our network.”

Empire has refused several offers made by the Alliance calling the proposed rates “not realistic.” Jill Hummel, Vice President of Health Services for Empire Blue Cross Blue Shield called the rates proposed by the Alliance as “far in excess of what we offer to comparable hospitals.”

The Alliance has maintained that the rates they have proposed, rates that Andrews claims are between a 50 to 60 percent increase from the pervious agreement, are “market rates,” rates similar to the ones the Alliance has with other insurance providers. Andrews says that Empire’s counter offers to the Alliance are in the “double-digits” but would not elaborate further. Hummel said “We put on the table a very substantial multi-year proposal,” one that she claims would be adequate to cover the operating needs of an efficiently run hospital.

Congressman Tim Bishop, who held a joint press conference with the Alliance on July 20, is not the only politician to side with the hospitals during the contract negotiations. State Assemblymen Fred W. Thiele, Jr. said “I come down on the side of hospitals.” Thiele says that the dispute between Empire and the Alliance is adversely effecting many of his constituents. Thiele as well as all of the other members of the New York State Assembly are policy holders of the states insurance plan, a plan Empire Blue Cross Blue Shield provides.

The failure of both sides to come to an agreement prompted the Alliance announced that they were going to hold a press conference on Friday August 7, at 10 a.m. at the Peconic Bay Medical Center in Riverhead. Expected to attend the press conference would be State Senator Kenneth P. LaValle, State Assemblymen Marc S. Alessi and Thiele. Thiele, a Republican, said that this press conference with Alessi, a Democrat, transcended partisan politics. “This is about the public welfare,” said Thiele.

However on Tuesday, August 4, a second press release was sent out announcing that the press conference would be cancelled. Thiele said the cancellation of the press conference was an “indicator that serious negotiations might restart.”

In photo above, Congressman Tim Bishop and Alliance spokesman Paul Connor at press conference two weeks ago.