Tag Archive | "Empire Blue Cross Blue Shield"

Empire and Hospital Alliance Forge Agreement

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By Bryan Boyhan

For the past eight months most subscribers to the East End’s largest health insurer were unable to enjoy the benefits of their insurance at the East End’s three local hospitals without first being admitted through the emergency room. Patients who are covered by Empire Blue Cross Blue Shield, which insures thousands of people in the five East End towns, including those employed by local school districts and municipalities, who needed to be admitted for procedures were told they would have to go to one of the other nearby hospitals, such as Brookhaven or Stony Brook University Medical Center, if they wanted to be covered.

The standoff between Empire and the three local hospitals in the East End Health Alliance — Southampton, Eastern Long Island and Peconic Bay Medical Center — ended last week with the signing of a 33-month agreement between the two parties. It also involved the behind-the-scenes help of a cast of local politicians, including assemblymen Fred Thiele and Marc Alessi, state senator Ken LaValle and, chiefly, congressman Tim Bishop, who Alliance spokesperson Paul Connor singled out.

“We are especially grateful for the unwavering support of Congresssman Tim Bishop, whose assistance was instrumental in bringing this negotiation to a conclusion,” said Connor in a statement.

The protracted negotiation hinged largely on one issue: at what rate the local hospitals would be reimbursed for service.

In an interview this week Connor, who is CEO of Eastern Long Island Hospital, said the Alliance was satisfied with the outcome.

“We wanted to get to a market rate and we achieved that,” he said.

During the negotiations, the Alliance argued the East End hospitals were not being reimbursed as well as other hospitals on Long Island. The relatively small size of the local medical facilities puts them at a disadvantage when negotiating, and was one of the reasons they joined together to form the Alliance.

“I would say we’ve reached an equitable agreement,” said Sally Kweskin, spokesperson for Empire. “It’s good for our members.”

All the while the Alliance was arguing they were not being reimbursed fairly, the insurance company said they only wanted to pay a rate that would prevent an increase in premiums to subscribers.

“We believe it achieves a balance between our cost and providing access,” said Kweskin. “We wanted an agreement that would be affordable to our members.”

Kweskin said the deal would not directly affect the cost of premiums.

“But that’s not to say other factors might not,” she quickly added. “Like the cost of pharmaceuticals or treatments.”

Said Connor: “It’s been an admittedly long road. At this time, however, we are forward looking and are pleased that we were able to reach an agreement with Empire that challenges us to be mindful of costs but also enables us to invest in initiatives and systems that will promote long term affordability and accessibility of healthcare services on Long Island for our growing communities.”

The newly-negotiated agreement runs through the end of the 2012 calendar year, and reinstates all the programs subscribers were entitled to, including both commercial and Medicare products.

While negotiations are completed with Empire, the Alliance is currently re-negotiating a contract with insurer Cigna.

“I wouldn’t be surprised if that went down to the wire, too,” said Connor.

He was, however, more optimistic about these negotiations.

“Empire was the only one we’ve ever gone out of network with.”


Empire and The Alliance Negotiate in Silence

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Now almost into the third week since the August 1 deadline passed, effectively excluding the three East End hospitals from the Empire Blue Cross Blue Shield coverage network and preventing East End residents from being covered when using their local area hospitals, both camps have grown quiet. The East End Health Alliance — comprised of Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital – has been at odds with health insurance provider Empire Blue Cross Blue Shield during the contract renegotiations over the rate of reimbursement that Empire gives for patient procedures.

Over the past weeks both Empire and the Alliance have been vocal in their displeasure with the other side. Congressman Tim Bishop, who came out on the side of the alliance, said “no reasonable person can describe Empire BCBS’s posture here as negotiating in good faith” at a July 20 press conference. While Jill Hummel, Vice President of Health Services for Empire Blue Cross Blue Shield, in an August 5 interview, called the Alliance “unconcerned” with their patients welfare before the August 1 deadline.

Accusations of lying and profit-mongering have been leveled on both sides, and negotiations looked for a while at a standstill. As late as August 5 Alliance Spokesperson Paul Connor III said that he was “not optimistic” about reaching a compromise with Empire anytime soon.

But what a difference a week makes, as an agreement between both parties looks more likely than ever. Last week both camps voluntarily agreed to an indefinite “quiet period” where they both agreed to put a halt to all press conferences and statements. An Empire spokesperson said the “quiet period” is meant to put an end to the bickering on both sides so the renegotiation process could go on unmolested.

Connor, wishing to respect the “quiet period”, refused to comment about the contract negotiation except to say that, “There has been a lot of discussion and negations with Blue Cross…some progress, I am more optimistic than I have been.” 

Bishop Aids Health Alliance in Fight With Empire

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By Andrew Rudansky

With only 11 days left before Empire Blue Cross Blue Shield’s contract with several area hospitals expires, The East End Health Alliance, a partnership between Southampton Hospital, Eastern Long Island Hospital in Greenport, and Peconic Bay Medical Center in Riverhead, is scrambling to return to the negotiating table. Congressman Tim Bishop, a Southampton native, intervening on behalf of the alliance held a press conference at the Southampton Hospital’s Parrish Memorial Hall this Monday, July 20 urging Empire BCBS to return to the negotiating table to renew the contract before the July 31 deadline.
“I don’t want to be melodramatic and suggest that we are on the verge of a health care crisis,” said Congressman Bishop, “but we are certainly on the verge of a tremendously adverse situation that affects public health on eastern Long Island.”
This situation should not be unfamiliar to many local residents, as this isn’t the first time the East End Health Alliance has run up against insurance companies. In May of 2008 with Oxford Health Insurance and then once again in September of 2008 with GHI/HIP, the Alliance both faced stern opposition at the negotiating table. In both of those cases the Alliance was able to successfully negotiate new contracts.

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Empire BCBS is much different than Oxford Health Insurance and GHI/HIP in terms of scope. Empire BCBS is Eastern Long Island’s largest health care provider, covering over 40% of all policy holders in the area. Many of these policy holders receive their Empire BCBS coverage from public schools and municipal jobs. The Alliance claims that they cover over 300,000 residents between the three of them, and if 40% of that number could no longer be covered by their insurance plan when they are admitted to those hospitals it would be, said Bishop, “intolerable and suggests that patient well-being is a secondary concern to [Empire BCBS’s] bottom line.”
Andrew J, Mitchell, President and CEO of Peconic Bay Medical Center said, “There are so many different varieties of health plans within the Empire BCBS product line, that it would be very difficult to estimate the number of people” that would be unable to come to Alliance hospitals due to insurance problems. Mitchell added that without adequate reimbursement from the insurance companies, Alliance hospitals could not provide the same scope of services that they currently do provide.
“[Current negotiations] are really going nowhere,” said Paul Connor III, President of Eastern Long Island Hospital and spokesperson for the East End Health Alliance. Connor was impressed with Congressman Bishop’s interest in the issue. “Tim [Bishop] is a tremendous advocate for our hospitals and health care,” said Connor.
Bishop used the platform to reiterate his support for a government alternative to the current health care system. “This is exhibit A on why we need comprehensive health care reform,” said Bishop.
If the contract expires before a settlement can be made many local area Empire BCBS policy holders could be redirected to hospitals in Patchogue or Port Jefferson, or be required to pay “more expensive out-of-network rates.”
Even if the two sides fail to come to some sort of agreement before the July 21 deadline, New York State law mandates that all emergency patients or pregnant women in their first trimester be admitted to a hospital regardless of their insurance status. Also only Alliance hospitals will be affected and personal doctors will remain unaffected.
“I believe this status results from Empire’s failure to negotiate in good faith,” wrote the congressman in a letter addressed to Mark Wagar, president and CEO of Empire BCBS and Angela F. Braly, president and CEO of WellPoint. The letter, written directly after the press conference, stated that the Alliance hospitals are asking for reimbursement rates similar to ones they have with other insurance providers. Similarly, according to the letter, the rates proposed by Empire BCBS would result in a loss of $500 per day by hospitals.
“No reasonable person can think that this is sustainable, no reasonable person can describe Empire BCBS’s posture here as negotiating in good faith,” said Bishop at the press conference.
George D. Keckeisen, MD, president of the Southampton Hospital Medical Staff, said, “This is a problem that needs to be addressed…and we hope that with the pressure we can bring to bear from the both health care provides, both the physicians community and nurses, in addition and in conjunction with the hospitals administration…that the Blue Cross provider will actually come to the table and make a realistic proposal that we can all live with.”
Bishop’s strongly worded letter concluded with the congressman saying that he might request a federal investigation of unfair practices in the negotiations if Empire BCBS does not capitulate to what Bishop believes are more reasonable rates.

Top: Congressman Tim Bishop with Paul Connor III, spokesman for the East End Health Alliance, at Monday’s press conference.

Inset: Bruce LaValle, R.N., speaking with Jasmine Dozier, R.N. (left) and Diane Groneman, R.N. (right).