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Sep 8, 2009 7:50 PMPublication: The East Hampton Press

No new settlements in Empire and Alliance negotiations

Sep 8, 2009 7:50 PM

Empire Blue Cross, New York State’s largest health insurance company, and the East End Health Alliance hospital network have yet to reach an agreement on health care reimbursement rates, officials said on Tuesday.

As a result, it has now been nearly six weeks since the contract between the insurance company and hospitals has expired and nearly six weeks that all Empire subscribers have been “out of network” and unable to receive most forms of care and treatment at local hospitals.

Empire Blue Cross Blue Shield and Alliance hospital representatives met at New York State Department of Insurance offices in Manhattan on Tuesday to continue negotiations, which began in May. Alliance member hospitals—Southampton Hospital, Peconic Bay Medical Center in Riverhead and Eastern Long Island Hospital in Greenport—went out of Empire’s coverage network on August 1. While an agreement was reached late last month regarding Empire’s Mediblue plan, a senior citizens plan, no settlements for Empire’s other health plans have been reached.

“We’re still in a quiet period” and focusing on negotiations, Empire spokesman Craig Andrews said. “Nothing has changed.”

Empire has claimed that Alliance hospitals are seeking a 40-to-60-percent reimbursement rate increase over 2008 rates. Alliance has argued that member hospitals lose money by treating Empire subscribers, because reimbursement rates are so low.

Alliance spokesman Paul Connor III hoped holding “productive” negotiations in Manhattan with state insurance department officials will help resolve disagreements. Negotiating teams on both sides for the past week focused on data relating to how rate reimbursement rates are calculated, he said.

“The sticking point is our rate proposal,” Mr. Connor said.

While he declined to comment on specifics in negotiations, insurance department spokesman Andy Mais said hospitals and insurance companies do not often need state help to settle differences. “We continue to offer our services as both parties continue their discussions in an attempt to reach an agreement,” he said. “What we’re trying to do is have them both in the same room to reach an agreement.”

Since Alliance hospitals went out of Empire’s coverage network last month, thousands of Empire subscribers have been forced to travel to other hospitals within Empire’s coverage network for elective treatment. The impasse has affected many municipalities that use Empire to cover its employees and retirees, including Southampton, Riverhead, East Hampton towns and Southampton Village. Suffolk County government alone has more than 48,000 employees, retirees and beneficiaries who subscribe to Empire.

As long as negotiations continue, United Health Care spokeswoman Mary McElrath-Jones said the likelihood is an agreement will be reached at 
some point. United Health Care entered into an agreement with Alliance hospital network in 2008. Peconic Bay Medical Center was taken out-of-network for a month until differences between it and United could be resolved, she said.

“It’s not unusual. We’ve had that happen in New York a few times,” Ms. McElrath-Jones said of hospitals going out-of-network. “We find that as long as both parties are negotiating and both are willing to negotiate in good faith, then 99 percent of the time then they will reach an agreement.”

Still, Alliance hospitals on Tuesday seemed unwavering in their call for higher reimbursement rates from Empire.

Alliance Board of Trustees member Dr. Agostino Cervone, who runs private practices in Riverhead and Southampton, said accepting low reimbursement rates from Empire is not acceptable.

“They can’t,” Dr. Cervone said. “Otherwise, other insurers will then come down to the rates that the lowest is at, and that will really put each of the hospitals in a bind.”

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Suffolk County (and everyone else) should be free to choose from any health plan in the USA, instead of being held hostage to the few choices we have under the foolish federal regulation that health insurance cannot be purchased across state lines. What we are witnessing is the behavior of a virtual monopoly. It's to be expected. Let free market competition put the pressure on Empire to offer subscibers the best deal.
Richard Blumenthal
http://shouldirun.com
By RichardBlumenthal (24), Westhampton Beach on Sep 8, 09 6:09 PM
1 member liked this comment
The solution to this perennial problem is to replace the three obsolete and inefficient hospitals on the East End with a regional medical center. The state and county governments should start planning for this now so that it can come to fruition within 20 years. A regional medical center that is a campus of the State University of New York would be perfect. It could tap into the well qualified pool of Residents that are attracted to first rate hospitals and ungrade the standard of care for everyone. ...more
By highhatsize (3794), East Quogue on Sep 8, 09 8:58 PM
Mr. Blumenthal, you say that we are witnessing a virtual monopoly and then you suggest we let free market competition put the pressure on Empire?! It is free market competition that brought us here in the first place and what is needed is reform and regulation. Instead you advocate buying insurance from another state. What if that state has even less regulation than New York? Your post is nothing more than a simple-minded parroting of republican talking points. As to your question: No, you ...more
By dagdavid (646), southampton on Sep 8, 09 9:38 PM
1 member liked this comment
Bush's tax cuts to the rich cost more than the proposed health care reform!

Enacted in 2001 and 2003, the Bush tax cuts are projected to cost about $2.1 trillion in lost revenue in the 10 years since they were first passed, according to Citizens for Tax Justice. About $979 billion of that would have come from the richest five percent of taxpayers.

By comparison, the health care plan advocated by House Democrats is projected to cost about $1 trillion through its first decade (2010-2019), ...more
By yearrounder (208), Southampton on Sep 9, 09 8:18 AM
Tax and spend tax and spend. Waste waste waste. Tax cuts help stimulate the economy. How much do you want to gouge the rich for. They already pay way more than their fair share for all the social service programs, waste and inefficiencies our GVT provides. In addition I truly believe the 1 trillion number is ridiculous low. They throw "projections" out there like they have a clue how this 1,100 page bill will play out. What a bunch of clowns
By razza5350 (1906), East Hampton on Sep 9, 09 9:40 AM
the last company i ran i provided healthcare to my nyc based employees by going with administaff--its a texas based payroll and health insurance provider--the way it worked was that the employees were technically employed by administaff and the health insurance was provided by having the employees (less than 30) belong to a pool of tens of thousands all regulated by texas state law, which disallows predatory medical malpractice suits. that worked for about 2 years until new york regulators and ...more
By davidf (325), hampton bays on Sep 9, 09 12:55 PM
These are the criminals that the right wants to defend:

"Blue Cross Blue Shield of North Dakota used premium payments to fund $15 million in employee bonuses, cover $35,000 for a retirement party and pay for other questionable expenses, according to a state audit released Tuesday"

Where were you anti-government, neocons when Bush was spending trillions on war and tax breaks for the rich?
By yearrounder (208), Southampton on Sep 9, 09 6:59 PM
The president put it well. Imagine having to turn to a sick child, parent, or spouse and saying, "There is something that can make you better, but we can't afford it." That is NOT hyperbole. That is NOT liberal propaganda. It happens every single day in this country and making sure that never happens again should not be a democratic of republican issue.

This is a moral issue.
By peoplefirst (787), Southampton on Sep 9, 09 9:33 PM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By razza5350 (1906), East Hampton on Sep 9, 09 10:27 PM
I guess my last comment was inappropriate. Let me rephrase it. I think I phyically see BS coming out of his mouth as he spoke.
1. Reduce the cost of care.
2. Allow competetion accross state lines.
3. If you want coverage universal make it mandatory and every MUST pay. Provide subsidies for low earner.
4. No GVT option. No 1100 page bill,no bureaucrats

By razza5350 (1906), East Hampton on Sep 10, 09 7:31 AM
razza, talk about bs - your neocon talking points are misguided and shown to have little to no effect on costs. Allowing competition across state lines means that you would have to deal with every states differing individual regulations and you think there is too much gov't involved now? How do you reduce the costs of care? The president gave a number of ways that even republicans agree with. Guess what, the president said there would be mandates.

I know it has been asked and unanswered ...more
By yearrounder (208), Southampton on Sep 10, 09 9:07 AM
Yearrounder eliminate state regulation and use the best of each states regulations to set federal guidlines. Allow competetion across state lines with rules and regulations set by the federal gvt. The state insurance departments are can make sure the rules are enforced. This will allow more choice and greater competetion
If I knew how to reduce the costs of care I wouldnt be here blogging with you. I BELIEVE tort reform, universal claim forms and improved claims processing will help. Unfortunately ...more
By razza5350 (1906), East Hampton on Sep 10, 09 9:37 AM
Yearrounder..one more thing Did you cry with joy when you heard the speech last night?
By razza5350 (1906), East Hampton on Sep 10, 09 9:55 AM
Blue Cross is doing what the government does with medicare. They are trying to keep the cost down so your premiums don't go up. The Presidents plan without a public option means cost will explode. With a public option Southampton would be forced to control costs but insurance companies will go out of business and more people lose jobs and less taxes come in. There are no simple solutions but somebody needs to control the providers as well. Make the insurance companies take less profit and put oversight ...more
By jekgbs (35), East Hampton on Sep 10, 09 5:36 PM
amen jekgbs. Your last sentence summoned it up. That is the root of the problem. Until they address ithe sky rocketing cost of care premiums will rise accordingly.
By razza5350 (1906), East Hampton on Sep 10, 09 6:18 PM
jekgbs, Not only will insurance companies NOT go out of business, every single study of the public option, including the non-partisan Senate Budget Committee, shows that the Obama health care plan WITH a public option AND a mandate will actually be a boon to private insurers, giving them the opportunity to add tens of millions of people to their plans.

The public option addresses the sky rocketing cost of premiums by introducing competition into the market place. If you think Blue Cross ...more
By yearrounder (208), Southampton on Sep 11, 09 9:55 AM
yearrounder The public option is dead they do not have the votes. The Dems killed it themselves by not being able to control their own senators. 60 Dems means you do not need Republicans but they don't have all their own people onboard. With that said mandating coverage will add millions for insurance companies not a public option since there will be none. I never said I was for or against a public option. I said without a public option covering pre-ex and adding millions of people and charging ...more
By jekgbs (35), East Hampton on Sep 11, 09 10:24 AM
Year rounder you are right. Health care stocks have been going through the roof. They would love to see mandated coverage but to imply that the public option would reduce cost is ludicrious. By saying so you believe either that iinsurance companies are in collusion with one another or you do not believe in free market capitalism. I believe the underlying problems are cost of care, issues with portability and individual coverage. I beleive the most important issue to address first is cost of care. ...more
By razza5350 (1906), East Hampton on Sep 11, 09 1:00 PM
No, razaa, I do not believe in unregulated markets. If you followed the walls street and bank debacles you would know that unregulated, free market capitalism has driven this country to the brink. Tort reform has been proven by countless case studies where it has been implemented, to reduce costs by no more than 2 to 3%. I do not hold to your, "government bad, corporations good" philosophy.

razaa, your naivete re: the insurance companies is befuddling to say the least. You believe the ...more
By yearrounder (208), Southampton on Sep 11, 09 1:34 PM
Yearrounder, I am with you. Unregulated, free-market capitalism is destroying the American way of life. Many seem to have forgotten the lessons of the Wall Street and Banking crises we are still facing.

Tax cuts to the rich, the wars in Iraq and Afghanistan and unregulated financial markets have brought us to the brink. Even republicans agree that unless something is done our economy will collapse under the weight of health care costs, the difference is they want to maintain the status ...more
By dagdavid (646), southampton on Sep 11, 09 1:44 PM
Forgot to mention: How about some proof of collusion right here at home:

Ingenix parent company UnitedHealth has already settled a similar lawsuit for $350 million. In order to avoid prosecution by the state of New York, the company also agreed to establish a new database under the supervision of that state's attorney general. UnitedHealth and Aetna have each agreed to contribute $20 million toward this database, while WellPoint has agreed to pay $10 million.

source: http://www.naturalnews.com/026740_insurance_companies_health_doctors.html ...more
By dagdavid (646), southampton on Sep 11, 09 1:47 PM
Yearrounder I guess you and I will never see I to eye but as they say dissent is patriotic. I disagree but respect your opinion. I consider myself a centrist/libetarian and it appears you are a statist. We are at the opposite ends of the spectrum in terms of beliefs. If you want to check something interesting out google fannie mae on You tube. It will show you another side to what helped the housing market and the banks collapse. Fannie Mae is a GVT run entity that dictated lending policies in ...more
By razza5350 (1906), East Hampton on Sep 11, 09 2:19 PM
dag,

You are correct. that is a great example of corruption and I'm glad they caught them but corruption runs rampant in the GVT as well. The numbers are far greater than 350 million. I'm glad we have the GVT to nail them for situations like that but who will nail the GVT for there misuse of funds?
By razza5350 (1906), East Hampton on Sep 11, 09 2:42 PM
Razaa, respectfully, you are wrong about Fannie Mae. First established in 1938 as a government agency, Fannie Mae in 1968 became a private, shareholder-owned company with a charter from Congress requiring the company to support the housing finance system. On September 7, 2008 the government placed them into Conservatorship.

I don't know about yearrounder, but I am a small business owner and I can tell you this: there is no choice in private insurance. They collude (as I've shown) to ...more
By dagdavid (646), southampton on Sep 11, 09 4:11 PM
Dag,
LOL Lets stick to health care. Fannie MAe is an arguement for another time When you say no choice I take it you are self employed. As a small business owner I do not face these options. I can cover my employees for as little as 200 per month through HealthNY. I have choices Oxford,Blue Cross, Health NET, HIP, Aetna, Cigna ect. Now based on this new reform package the GVT is telling me I MUST cover all employees (I do). If I don't I will have to pay an 8% payroll tax. Should be great for ...more
By razza5350 (1906), East Hampton on Sep 11, 09 5:13 PM
dagdave GHI covers you for $183 per month with a $5800 deductible...but you can save the rest through an HSA. I voted for change but covering pre-ex around the coutnry and with all plans might be the best change we have....I love a good fight but truth is there are no simple answers...
By jekgbs (35), East Hampton on Sep 11, 09 9:21 PM
Empire enrolees are treated at 99% of hospitals around the state, in fact 90% of the country accepts empire reimbursement. Is Southampton Hospital too upity to accept payement that most hospitals accept. That is pure greed and what Obama's health care reform should focus on. Boycott Southampton Hospital!
By Walt (277), Southampton on Sep 12, 09 1:18 AM
This comment has been removed because it is a duplicate, off-topic or contains inappropriate content.
By Walt (277), Southampton on Sep 12, 09 1:18 AM
Razaa, interesting - you bring up Fannie Mae as an example of a gov't run agency that doesn't work. When provided with factual data that disproves your point you say "LOL that's for another time." This constant flow of misinformation from those against health care reform is what drives me mad. You only want to discuss a point that suits your argument and then drop it when disproved, but that is not healthy debate.

I am not only concerned for myself, but for those who have no access ...more
By dagdavid (646), southampton on Sep 12, 09 12:31 PM
Google fannie mae and click on Wikipedia to learn more factual information about fannie mae. Fannie Mae was created to provide affordable housing to people who couldnt afford it with basically no money down. Check out you tube "fannie mae" as well.
By razza5350 (1906), East Hampton on Sep 12, 09 1:25 PM
gurney's, new year's eve, celebration, montauk