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Feb 23, 2010 5:01 PMPublication: The East Hampton Press

Empire and hospitals find new deal elusive

Feb 23, 2010 5:01 PM

After having come tantalizingly close to a contract agreement last month, the pace of negotiations between the East End Health Alliance and Empire BlueCross Blue Shield seems to have slowed and, again, there is no tangible finish line in sight.

Representatives from both sides acknowledged last week that progress is taking longer than either party had anticipated after some positive developments in January, but both sides remain optimistic. Two areas that are still under discussion include a rate sheet analysis, which helps establish reimbursement rates for various medical procedures, and the contract language. The reimbursement rates that Empire pays to the three hospitals and their doctors for various types of care have proven to be a significant issue in the talks, which have lasted for most of last year and extended into 2010.

“It’s a tedious process to make sure the rates are where we’d like them to be,” explained Paul J. Connor, spokesman for the Alliance, which comprises Southampton Hospital, Peconic Bay Medical Center in Riverhead, and Eastern Long Island Hospital in Greenport.

“We’re still in the trenches hammering out the details,” said Sally Kweskin, director of corporate communications for Empire, “but we’re hopeful and optimistic that we can come to a resolution and a fair and equitable contract.”

In the meantime, the process has been interminable for thousands of East Enders, causing many to pay higher co-pays for treatment or to forgo routine tests and procedures altogether. The Alliance hospitals have been operating out of network with Empire since August 1. Only emergency care and other approved procedures and treatment have been covered at the local hospitals for Empire policyholders since then.

State Senator Kenneth P. LaValle, who has been following the negotiations closely, said last week that if a contract has not been achieved within one week, he would investigate what pressures the state might be able to apply in order to hasten the process.

“I think this has dragged this on far too long,” said Mr. LaValle. “If we were talking about children, we would send them to their rooms without dinner.”

Mr. LaValle accused Empire of wielding a browbeating stance in negotiations. “They’re the largest provider, and they’re acting like bullies with the hospitals,” he said.

Meanwhile, the Alliance has recently signed a contract with Aetna. The contract agreement was announced on February 1 and will last until the end of the year, keeping the three Alliance hospitals in Aetna’s network.

The Alliance’s contract with United Healthcare Oxford is set to expire in July.

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And yet my co-pay just went up as well as my rates! This is all so frustrating.
By Mrs.Sea (268), Sag Harbor on Feb 25, 10 9:28 AM
the big gouge attck continues from big insurance- sigh
By lo-cal (78), southampton on Feb 25, 10 6:29 PM