Tag Archive | "Empire BlueCross BlueShield"

Empire and Health Alliance Near a Resolution

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By Bryan Boyhan

After months of grim news — or no news — there is a tone of optimism in the voices of those in the middle of the negotiations between the three East End hospitals and the region’s largest insurer, Empire BlueCross BlueShield. Since this past summer the sides have been at impasse, struggling mostly over the cost of reimbursement the insurance company would pay the hospitals of the East End Health Alliance, including Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital.

The impasse has put those hospitals out of the Empire network and, except for emergency care and a handful of other provisions, has forced Empire-insured patients to hospitals further west — such as Brookhaven Memorial and Stony Brook University — if they want to be covered by insurance.

“We’re very optimistic,” said Empire BlueShield BlueCross director of public relations Sally Kweskin, yesterday. “We’re keeping on track with negotiations.”

This is good news for the Empire-insured, since much of the talk over the past few months has been that the two sides were far apart and it was increasingly unlikely that negotiations would be successful.

“We’re looking to have some resolution in about two weeks,” said Kweskin.

“There are still some fundamental issues,” she said, “but we have made some progress on outside issues.”

The Alliance would agree.

“For the past couple of weeks we’ve made more progress on key issues than we have in the past five months,” said Paul Connor, president of Eastern Long Island Hospital and spokesperson for the Alliance.

He added, however: “I need to be cautious here. There is still work to do.”

Connor was hesitant to put a time frame on the negotiations, and said working out reimbursement schedules was “a fairly complex process.”

“There are all different types of rates,” he said.

Connor said there was no particular turning point that seemed to allow negotiations to open up.

“As time went by, we found more things we could compromise on,” he said.

He also credited Congressman Tim Bishop for helping to keep the two sides focused and moving forward.

“He’s been working very much in the background,” said Connor. “We’ve had a lot of help with this.”

At present, Empire-insured patients have full access to their doctors, but only limited access to the local hospitals. If admitted under emergency status, patients would enjoy the benefits of their prescribed coverage. But for scheduled procedures, they would need to go to an in-network hospital in order to get insurance benefits. The exception to this under certain plans would be if the patient lived beyond thirty miles of an in-network hospital.

Patients who are receiving benefits at one of the three member hospitals will be reimbursed directly by Empire. Those checks must then be signed over to the hospital as payment for the service.

Empire Moves to Make Sure Local Docs Stay in Network

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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.

Sick Day

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Health care. Do you have it? If not, you’re out of luck. If so, you’re one of the lucky ones. Especially if your employer picks up the entire premium for you. Or maybe your health care cup is half full. Yes, you have health insurance — but your employer pays half or less of the premium. Which means, given the cost of premiums these days, much of your salary goes just to ensure you have coverage.

Unless of course, you have Empire Blue Cross/Blue Shield. In which case, right now, your hard earned dollars are going to a company that says you can’t even use your insurance at the three nearest hospitals.

Hmmm. And people are saying we don’t need health care reform in this country? That’s just sick.

It’s time for real and civilized debate on this topic. Let’s stop all this dog and pony show nonsense. Because this system just ain’t working.