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Sep 15, 2009 4:49 PMPublication: The East Hampton Press

Empire subscribers can stay with doctors

Sep 15, 2009 4:49 PM

East End physicians who accept Empire Blue Cross Blue Shield will stay in network with Empire as contract negotiations with East End Health Alliance hospitals continue, meaning thousands of local subscribers will be able to stay with their current doctors.

Though the hospitals themselves continue to remain out of Empire’s network, the agreement reached on Friday by Empire and Alliance will allow patients to stay with their physicians of choice rather than be forced to find other physicians within Empire’s network, Alliance spokesman Paul Connor III said.

At least 60 physicians are impacted by the agreement, which requires Empire to continue offering reimbursements for care given by physicians to Empire subscribers, he said. The physicians, who all serve on the staff at Alliance member hospitals, were previously in jeopardy of going out of network on September 29.

Earlier this year, patients received notices that their doctors would be out of network, but will now receive another letter rescinding the out-of-network status, according to a statement released by the Alliance.

“I don’t have to tell you that the physician-patient relationship is important,” Mr. Connor said. “For a patient to have to find a new physician because of a health insurance issue is difficult for patients to deal with.”

Alliance member hospitals include Southampton Hospital, Peconic Bay Medical Center in Riverhead and Eastern Long Island Hospital in Greenport.

Though this agreement represents the latest breakthrough since Alliance hospitals were taken out of network on August 1, the two sides remained locked in contract negotiations this week—the seventh week since their last contract expired. 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 reimbursements.

Last month, both sides reached an agreement to allow seniors that subscribe to Empire’s Mediblue plan to have unrestricted access to hospital care.

Both sides continue to be at odds over how much money Empire should reimburse hospitals for care given to Empire patients that subscribe to Empire’s other health insurance plans. Negotiations over rate reimbursements began in May, with few agreements reached.

The contract impasse has affected thousands of people living on the East End who subscribe to Empire for health coverage. Because hospitals are out of network, Empire does not cover subscribers seeking anything other than emergency care at East End hospitals.

To help lessen the burden, Alliance hospitals 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 negotiations continue.

Talks between Empire and Alliance negotiation teams were expected to continue this week in an attempt to resolve the ongoing contract impasse, Mr. Connor said.

“We are at the table and negotiating and everybody is negotiating in good faith,” he said. “We can only hope that we can resolve negotiations soon.”

Meanwhile, some health insurance brokers said their clients who subscribe to Empire have so far chosen to stay with the company, even though some have contracts that would allow them to opt out given the circumstances. But if the negotiations drag on much longer, some of those brokers said they might recommend a change.

Michael Grant, president of employee benefits at USI, one of the largest insurance brokerages in the nation, said the more than 300 businesses he represents that subscribe to Empire have opted not to switch providers—so far. “We’re not seeing a lot of clients leaving Empire as a result of this [impasse],” Mr. Grant said. “But we are seeing a lot of discussion. There is a lot of wait and see with this right now.”

Mr. Grant predicted that Empire would raise its premiums for subscribers if Empire agrees to the higher reimbursement rates that the East End hospitals are demanding. And if Empire raises its premiums, it risks losing more subscribers, he said.

“This is a critical time for Empire,” Mr. Grant said. “I understand why they are in a stalemate, because people can’t afford [higher premiums], yet the hospitals need more money.”

Anthony Cardona, a sales executive at Maran Corporate Risk Associates of Southampton, said he has advised his more than 50 Empire clients to “stick tight” and wait for both sides to reach an agreement.

Mr. Cardona was among a number of area insurance brokers who were expected to travel to Riverhead on Tuesday for a briefing with Alliance hospital officials about the status of the contract negotiations with Empire.

Unless the impasse ends soon, Mr. Cardona said he might revise his opinion and begin advising his clients to consider other health insurance providers.

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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 5:04 PM