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Aug 4, 2009 6:14 PMPublication: The East Hampton Press

Hospitals and insurer fail to reach agreement; Empire not accepted at East End hospitals

Aug 4, 2009 6:14 PM

Mr. Connor said that the Alliance hospitals lose money when they treat Empire policyholders, because Empire is paying less than the cost of care. He also pointed out that while Empire’s parent company WellPoint had a profit of $2.5 billion in 2007, the Alliance hospitals collectively lost $12 million.

Jill Hummel, vice president of health services for Empire, said the hospitals cannot just consider their revenues when they look at their profit margins, saying they need to look at their expenses and make necessary cuts.

“We absolutely don’t have high expenses,” Mr. Connor asserted. He said the medical facilities’ expenses are below the national average and they are probably some of the lowest-cost hospitals on Long Island. He added that the Alliance hospitals are constantly looking for ways to trim costs.

The Alliance issued a press release Friday announcing the adoption of a policy designed to assist Empire policyholders who may incur greater medical costs. Under this policy, the hospitals will not pursue collection of a patient’s out-of-network coinsurance obligation—to the extent it exceeds the patient’s in-network obligation. Patients will remain responsible for their deductibles under the policy.

“The Alliance hospitals have adopted this policy because it does not support Empire out-of-network policies that financially penalize patients who seek medical care at a local East End hospital rather than be forced to travel long distances to other hospitals in the Empire network,” the press release reads.

This policy applies to Empire members with commercial plans and to self-insured plans administered by Empire, but it does not apply to Empire’s senior plan members.

According to the Alliance, under some Empire plans, patients will continue to receive in-network benefits if the patient lives more than 30 miles from a participating Empire hospital.

Each of the hospitals has set up a special Blue Cross help line for Empire policyholders. Southampton Hospital’s is (631) 726-8555. Peconic Bay Medical Center’s is (631) 574-8400. Eastern Long Island Hospital’s is (631) 477-5100. The Alliance hospitals are also posting updates to their website, healli.org.

Empire has posted updates on the negotiations and what policyholders can do now to its website, empireblue.com. Mr. Andrews said Empire’s customer service line, (800) 495-9323, is taking calls over the weekend.

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Wow, glad I don't work in the ER this weekend!
By barnbabe (64), westhampton beach on Jul 31, 09 10:05 PM
Clearly time for the public option folks! Just about every state, city and local worker elects Empire so now, effectively, they have no coverage at all. They paid premiums for nothing.
By lulubelle1956 (24), Westhampton Beach on Jul 31, 09 10:54 PM
By pinga (90), hamptonbays on Aug 1, 09 8:01 AM
First they decrease coverage and increase the copay by 50%, now we can't use any of the local hospitals. Why should I continue to pay for coverage I don't have ! All policyholders including their employers in the area, should receive a rebate for the period of time they have no coverage.
By graibierd (6), Southampton on Aug 1, 09 1:28 PM
Wasn't Representative Tim Bishop going to do something about this?

Or was that just one of his press releases?
By Frank Wheeler (1826), Northampton on Aug 1, 09 6:36 PM
1 member liked this comment
This is why we need single payer in this country. We won't get that this way around, but maybe we'll get a robust public option.
By peoplefirst (787), Southampton on Aug 1, 09 7:21 PM
1 member liked this comment
This does not petain to town o village employees...they have The Empie plan which is United Healthcare NO Empire BCBS. otally diffeent. Don't start a panic with wrong info!!!!
By squeaky (291), hampton bays on Aug 1, 09 7:29 PM
1 member liked this comment
OMG! my keyboard is sticking! The EMPIRE PLAN is NOT BCBS! Its Empire BCBS that is in trouble here not the town and village insurance.
By squeaky (291), hampton bays on Aug 1, 09 7:31 PM
This is a phenomenon upon which to construct a new paradigm of health care for the East End. The Alliance will, according to the article, continue to provide care for Empire BC insureds in emergency cases. Thereafter, one assumes, they will be transported to a hospital further west for continued, non-emergency care.

Why not make this system permanent? Downscale the three Alliance hospitals so that they are just emergency trauma centers and build a modern regional medical center for the ...more
By highhatsize (4217), East Quogue on Aug 1, 09 11:06 PM
By sjk631 (1), east hampton on Aug 2, 09 8:13 AM
Sorry Squeaky but you are wrong on The Empire Plan. The Emipre Plan is United Heathcare for Dr. visits but it is BCBS for hospital care. So empire Plan patients are in the same situation except that they have out of network benefits and will need to pay their deductibles before the insurance kicks in.
By Medical Biller (1), Hampton Bays on Aug 2, 09 9:38 AM
1 member liked this comment
go to any city, town or village in america. the people that depend on the governement for everything, including healthcare are less healthy and worse off than the folks that take care of themselves. so if a little healthy negotiation throws you off to the point where you want to sign off your and your family's personal freedoms to the THE MAN, go ahead, but leave me out of it.
By thetruthhurts (21), southampton on Aug 3, 09 7:11 AM
These hospitals have the power and don't realize it? Empire CANNOT sell their product on the East End if the hospitals refuse to accept them, so Empire must negotiate in good faith. Empire is not the only insurer on the East End...how about Oxfort, GHI, Aetna, CIGNA, Island Group, HIP??? And, please, don't start with the one payor system. The government can't get Medicare right or the auto and bank bailouts...and you want to trust our healthcare system to them?!
By nauti lady (25), Sag Harbor on Aug 4, 09 12:10 PM
Single payer health care and publicly funded elections
By peoplefirst (787), Southampton on Aug 4, 09 2:57 PM
Greed, greed, greed, avarice, and the price of malpractice insurance.

What does the hospital's CEO get a year, 3.5 million at last public mention.

Most of the problem is the jokers who run these outfits.
By Mr. Z (11847), North Sea on Aug 4, 09 7:17 PM
1 member liked this comment
For our elucidation, Alliance could publish the reimbursement rate that it is requesting for certain well-known procedures and the rate that Empire is willing to pay, together with the rate it pays Brookhaven. That would give us an idea of how far apart and how reasonable both sides are.
By highhatsize (4217), East Quogue on Aug 4, 09 7:29 PM
Squeaky - Empire is Blue Cross Blue Shield For Town, County and State Employees.... United Health Care pays your doctor. Blue Cross pays the Hospital. I see someone else already corrected you...

Empires reimbursement rates are to East End Hospitals is riduculously low. Look at EOB when they come in the mail and see how much they pay to the hospital for your procedure or ER visit. The amount that is not covered is ridiculous. No wonder our local hospitals are in such financial turmoil.
By newsgeek (3), East Quogue on Aug 4, 09 10:53 PM
1 member liked this comment
1. The Hospital is still in negotiations with Blue Cross
2. You can still go to the Hospital for emergency care
3. Most doctors are still contracted with Blue Cross until Oct.1
4. Blue Cross is NOT United Health Care (they are parent company of Oxford)
5. If you have the state, county or medicare plan you are unaffected (sorry EH Town)
6. If you need elective surgery you can call Blue Cross and request that it be treated in network if you do not have a facility within a certain ...more
By razza5350 (1911), East Hampton on Aug 6, 09 9:42 AM
1 member liked this comment
I work for the county & yes WE ARE affected!!!!!
By reddawn4125 (1), Riverhead on Aug 6, 09 10:42 AM
to all civil service employee's status of hospital negotiations.Empie bluecross blueshield's [ebcbs]contracts with certain hospitals located in suffolk county are due to expire effective 8/01/09.east end health alliance[eeha]is comprised of eastern long island hospital,peconic bay medical center and southampton hospital.to date,negotiations with eeha have been unsuccessful.effective 8/01/09 eeha facilities will no longer be network facilities under the empire plan hospital program.information on ...more
By asurest (117), easthampton on Aug 6, 09 7:14 PM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By dagdavid (646), southampton on Aug 7, 09 8:06 AM