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Jul 14, 2009 10:53 AMPublication: The East Hampton Press

Hospitals near deadline with major insurer

Jul 14, 2009 10:53 AM

By Brendan O’Reilly

Letters have been distributed this month to East End doctors, with letters to patients and employers to follow, warning that the end of the Empire Blue Cross Blue Shield’s contract with the three regional hospitals is approaching.

Empire will warn patients that if the insurance company and the hospitals—Southampton Hospital, Peconic Bay Medical Center in Riverhead, and Eastern Long Island Hospital in Greenport—cannot agree to a contract extension or new deal before August 1, beginning on that day Empire insurance will no longer be accepted at the medical facilities, except in case of an emergency. Empire is the largest insurer in Southampton Hospital’s service area. It accounts for about 18 percent of the hospital’s inpatient admissions.

This week, the insurer will inform doctors affiliated with the hospitals that, once the deadline passes with no new deal, if the doctors do not have the privilege of admitting patients to another hospital in Empire’s network, the doctors will be dropped from Empire’s rolls.

The three hospitals, which comprise the East End Health Alliance, are looking to strike a deal with Empire that includes compensation for procedures at rates that compare to what hospitals in western Suffolk County are paid for care. Empire says the hospitals are demanding unacceptable double-digit percentage increases in rates of reimbursement.

“We have been willing—as we do with all hospital partners—to agree to reasonable increases based on costs and reasonable needs,” Empire spokesman Craig Andrews wrote in an e-mail Friday. “We are hopeful that we will reach a reasonable resolution before the deadline—but, again, double-digit increases are not acceptable to our members, their families, and the employers and unions who help pay for their coverage in this difficult economy.”

East End Health Alliance spokesman Paul Connor III said earlier this month that Empire has been refusing to entertain the Health Alliance’s offers. He said that the hospitals are not looking for outrageous increases, only to be paid at the market rate for health care that other private insurance companies have agreed to pay. “Blue Cross is being asked to do nothing more, nothing less, than those other payers,” he said.

Mr. Conner said people concerned with the hospitals’ ongoing negotiations with Empire and what it will mean for their access to health care can visit the East End Health Alliance website, healli.org/bluecross.html, for updates.

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This is ridiculous!
By hhhub (10), speonk on Jul 10, 09 10:20 AM
This puts all of the local long time year round residents out on a limb for services, I guess all the other Hospitals up West will be making more of a profit as that's where the enrollees choices are..............hmmmm and Southampton Hospital is NOW only turning a profit.
By DiDi (16), Southampton on Jul 16, 09 4:35 PM
While the article is silent, I think that the cause of Empire's refusal is that the outcomes of procedures in the East End Health Alliance is substantially worse than those is larger hospitals further west on the island. Inefficient care adds cost to a procedure. I assume that Blue Cross has analyzed the cost per diagnostic related group of the East End Health Alliance and determined that the lower reimbursement rate that they offer them equals the higher rate they offer more efficient hospitals ...more
By highhatsize (3735), East Quogue on Jul 22, 09 3:06 AM