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Sep 14, 2009 11:30 AMPublication: The Southampton Press

Empire doctors will remain in-network

Sep 14, 2009 11:30 AM

Doctors who were expected to go out of network for patients who have Empire Blue Cross/Blue Shield health insurance will remain in network, as the insurance company continues negotiations with the East End Health Alliance network of hospitals. This new development was announced by Alliance after a negotiating session between the two sides at Empire’s office in Melville on Thursday, September 10.

Last month, both sides in the negotiations said that doctors who have admitting privileges only at Alliance hospitals would be out-of-network for Empire patients beginning on Tuesday, September 29.

Alliance representatives said in a statement Friday that patients who have received notices that their doctors will be out-of-network will receive another letter rescinding the out-of-network status.

In order for doctors to have admitting privileges at a given hospital, they must agree to be on hand for emergency room calls, and many doctors on the East End only have admitting privileges at one or more of the three East End Hospitals—Southampton Hospital, Peconic Bay Medical Center in Riverhead and Eastern Long Island Hospital in Greenport—because of the long commute required to remain on call at hospitals farther afield.

Alliance representatives have said that the hospitals actually lose money by treating Empire customers because the insurance company pays so little, while Empire representatives balked at the hospitals’ request of a 40 to 60 percent increase in reimbursement.

The negotiations began in May, and the three East End hospitals went out-of-network at the beginning of August. In late August, both sides reached an agreement to allow Empire Medicare patients using the Mediblue plan to access care at the hospitals, which both sides called the first step in settling the negotiations.

Alliance’s statement after Thursday’s meeting, which included representatives of the State Insurance Department, said that “both sides have agreed to engage in a concerted effort over the next two weeks in an attempt to resolve the contract impasse.”

The three hospitals also recently instituted a financial aid policy for Empire patients while out-of-network, allowing patients to pay their usual deductibles for use of the hospital while an agreement is reached. Emergency room use and inpatient admissions through the emergency room are covered by Empire, as is required by law.

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It is unfortunate. Even though Southampton Hospital is a secound rate Hospital it is vital to the community. I find it appalling they are spending money like drunken sailors with one hand and crying poverty with the other.

Blue Cross should be ashamed as well. Why is it we pay Long Island rates yet they continously pay suffolk hospitals less. They should charge us seperate rates from Nassau or pay the docs and hospitals out here more. I guess there logic is If you need heart surgery, have ...more
By razza5350 (1911), East Hampton on Sep 12, 09 9:03 PM
This is a perfect example of why a public option, or at least genuine competition is needed in the health insurance marketplace. If customers felt like they could pick up and go elsewhere for coverage, they would, as it's obvious that Empire exists to provide for their bottom line, not for the health and well being of their clients.
By M. O'Connor (147), Southampton on Sep 13, 09 6:26 PM
1 member liked this comment
razza5350, you can bet that such spending will only be MORE of an issue than ever before under Mr. Chaloner...
By eastendlocal (28), southampton on Sep 13, 09 10:08 PM
Cant be any worse than it was under Ferry. I actually believe Chaloner hasn't doen a bad job. From a dollar and cent stand point he has been successful in getting more money from insurance companies and has greatly improved their liquidity. His PR has been great. They are spending more money and yet crying poverty. Question is will it come back to bite him in the butt like it did with Ferry's overspending.
M Oconnor clients CAN pick up and go elsewhere. The hospital takes Aetna, Cigna, GHI, ...more
By razza5350 (1911), East Hampton on Sep 14, 09 9:31 AM
A new study finds that a majority of physicians support the creation of a public health care option.

A Robert Wood Johnson Foundation (RWJF) study published in Monday's New England Journal of Medicine shows that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance. If the additional 10 percent of doctors who support an entirely public health system are included, then approximately three out of four physicians nationwide ...more
By dagdavid (646), southampton on Sep 14, 09 7:47 PM
1 member liked this comment
Well, if Chaloner's past record at his last two institutions is any indication, SH Hospital will surely be bitten sooner or later...
By eastendlocal (28), southampton on Sep 14, 09 8:58 PM
Lets hopn not
By razza5350 (1911), East Hampton on Sep 14, 09 9:24 PM
dag, you should stickt to sharing your own point of view, rather than misrepresenting those of or nation's physicians. physicians are currently in washington trying to get congress to understand that NONE of their concerns are being addressed, they feel completely left out of the legislative process and that tort reform is their number 1 goal. try reading the physician's blog at sermo.

physicians also point, and rightly so, to the fact that the medicare drug plan has tripled in price ...more
By hamptons surfer (79), southampton on Sep 15, 09 6:15 AM
I know many folks like to ignore facts, but that just means they need to be repeated.

A new study finds that a majority of physicians support the creation of a public health care option.

A Robert Wood Johnson Foundation (RWJF) study published in Monday's New England Journal of Medicine shows that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance. If the additional 10 percent of doctors who support an entirely ...more
By dagdavid (646), southampton on Sep 15, 09 8:15 AM
Dag you have done it. You have found a study that PROVES once and for all that we should have a public option. Good Job! Thanks for that piece of useful information
By razza5350 (1911), East Hampton on Sep 15, 09 8:34 AM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By yearrounder (208), Southampton on Sep 15, 09 3:45 PM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By yearrounder (208), Southampton on Sep 15, 09 3:48 PM
The Bill for Illegal immigrants has come due. Hospital have too many non paying customers and they want Blue Cross to pay their share. BC refuses and we suffer. The Gov't option will pass because we are now paying for all of the GM retiree's luxurious health care. Include that to the burden the Hospitals are adding to their bottom line with servicing non paying clients and the refusal of the Insurance Co's to pay their share and you have no choice but to add a Gov't option. The alternative is to ...more
By Dr Spock (36), Hampton Bays on Sep 16, 09 5:09 PM
I am a member of the NYS Empire Plan and have never jherad of the problems empire is having with the alliance. I have been hospitalized across the country and have had noo problem finding a hospital that woudn't take empire as payment in full. The problem here appears to be these three hospitals and their doctors who refuse to take lower rates than other doctors and hospitals across the nation. This is not an example of why we need a public option as it is not the fault of the insurance company, ...more
By Walt (292), Southampton on Sep 18, 09 6:54 PM
Where does DagDavid get his facts? The AMA only supports the Obama plan because they have been promised billions of additional dollars in fees to do so. The real problem with health care is the greedy doctors and hospitals, not the insurance companies.
By Walt (292), Southampton on Sep 18, 09 6:56 PM
Walt I defenitely do not agree with Dag but I do feel we need insurance reform. I agree with you 100% that the cost of care is the most important issue to address and I have zero confidence in the GVT managing our healthcare. I feel insurance reform and tort reform should be included in any health care reform bill proposed. In regards to the hospital situation they are both being greedy pigs. If Blue cross is going to pay southampton less than other hospitals then why cant they charge their hampton ...more
By razza5350 (1911), East Hampton on Sep 19, 09 7:20 AM