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Oct 27, 2009 8:08 PMPublication: The East Hampton Press

Empire and Alliance resume attacks as hospitals remain without contract

Oct 27, 2009 8:08 PM

Their cease fire having expired and a contract resolution nowhere in sight, Empire Blue Cross Blue Shield and the East End Health Alliance renewed attacks against each other late last week.

Following the expiration of their mutual “quiet period,” Empire renewed its criticisms that the Alliance hospitals are seeking too high of an increase—60 percent over 21 months, they said—on their reimbursement rates. In turn, the Alliance has gone back to asserting that “Empire puts profits over patients,” a cry previously used in newspaper advertisements, and has posted on its website that “Empire pays us less than it costs to treat you and your family” when compared to other insurers.

Empire spokesman Craig Andrews said contract negotiations have made little headway over the past several months, despite Empire offering Alliance at least three different proposals for a contract. The latest proposal considered by the Alliance Board of Trustees included a “substantial” rate increase and a one-time payment to Alliance hospitals for building and equipment investments, he said.

“We chose to let [the quiet period] expire this time because, in short, there really wasn’t much movement 
going on on their part,” Mr. Andrews said. “We have made several offers, and they have come back with nothing different from their original request ... essentially, the same 60-percent increase.

“When it came down to it, for our customers and members, that request is just not reasonable right now,” he said.

The Alliance hospitals—Southampton Hospital, Peconic Bay Medical Center in Riverhead, and Eastern Long Island Hospital in Greenport—remained out of Empire’s coverage network for the 12th week in a row. Their contract expired on August 1.

Alliance spokesman Paul Connor III said both sides are still trading information, but he acknowledged that little progress has been made in negotiations.

“There is still some distance between what the Alliance requires and what Empire is willing to offer,” Mr. Connor said.

“We offered to extend the quiet period, they declined. That’s fine,” he added. “Though the talks may not be making huge progress, we still believe in a dialogue.”

Because Alliance hospitals are out of Empire’s network, most subscribers to Empire are unable to use their health plans at Alliance hospitals for anything other than emergency care and approved procedures and treatment. Seniors subscribing to Empire’s MediBlue plan are able to access hospital care thanks to a settlement reached by the parties on that plan in late August.

Under normal circumstances, Empire directly reimburses hospitals for care given to patients. But due to the contract impasse, patients now receive a bill from a hospital and then relay that bill to Empire. After that, Empire will send patients a reimbursement check, and patients are responsible for relaying that check to the hospital where they received care.

On its website, the Alliance notes that Empire’s parent company, WellPoint, earned record profits last year, while Empire continued to offer low reimbursement rates to East End hospitals and increase premiums for subscribers.

“Its low reimbursement rates and large premium increases allow Empire’s parent company, the insurance giant WellPoint, to post huge profits, including $2.5 billion in 2008,” the statement reads. “We’re asking Empire for fair reimbursement rates comparable to those paid by the other managed care insurance companies.”

But Mr. Andrews said Empire offered Alliance fair proposals for a contract. “What we did propose [was] adequate compensation and investment in the community and their facilities,” he said.

Meanwhile, State Assemblyman Fred W. Thiele Jr. of Sag Harbor openly criticized Empire this week. In a press release he issued about 
Governor David Paterson’s proposed budget cuts—which Mr. Thiele 
says will take $328,000 in state funding away from Southampton Hospital, $402,000 from Peconic Bay Medical Center, and $540,000 from Eastern Long Island Hospital—the assemblyman took a shot at the insurance company.

“We are seeing the imbalance in health care right in our own backyard. Empire/Blue Cross is utilizing its excessive profits and sheer 
size in an effort to impose unfair reimbursement rates on our local hospitals by starving them of cash during 
the current impasse,” he is quoted as saying. “Health care should be about patients, not profits and stockholders.”

Mr. Thiele went on to say that he opposes Mr. Paterson’s proposed cuts.

“Rather than impact local health services, the governor should be focusing his attention on health insurance companies and HMOs. At the same time that hospitals are in the red and receiving insurance reimbursement rates that are lower than even Medicaid, insurance companies continue to reap obscene record profit levels,” his press release said. “Instead of bankrupting community hospitals, the governor may want to consider a comprehensive reform that reins in excessive profits and returns that money to the ‘heart’ of the health care system: our local hospitals.”

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When Empire does pay it's often so late that doctors have already turned the accounts over to collection agencies. Private insurance should be illegal.

In the meantime people should bail out of Empire if not health insurance all together. Why pay for something you don't get?
By Noah Way (450), Southampton on Oct 22, 09 4:37 PM
Empire is paying the going rate for that procedure. If Alliance Hospital and doctors refuse to accept that rate, then the patient owes them the difference between the Emire reimbursement and billing rate by hospital/doctor. Blame you hospital and doctors for being too greedy. Empire dpesn't arbitrarily set rates for medical procedures, they have their own clinicins. Every other hospital/doctor group in the country acepts Empire rates. Why not the East End of Long Island? Maybe the doctors ...more
By Walt (292), Southampton on Oct 25, 09 12:07 PM
hospitals and doctors are not legal allowed to bill for what ins does not pay. If the bill is 20 dollars and empire pays $5, the copay is $5 then the $10 left over is written off. Its a loss. I know of no doctors worried about funding their social life as much as paying their necessary office staff. Try and get a precertification for a CT your doctor ordered without us!
By squeaky (291), hampton bays on Oct 29, 09 10:39 AM
I dropped Empire rather than wait around. The good news is that it looks like we are going to see health care reform legislation pass in this country and we may even get a robust public option.

After all of the insanity from the right in August, cooler, saner heads have prevailed and a majority of Americans wan't real reform. Ask yourself this: What do insurance companies add to your health? They exist solely to make profit and it is time we start caring for our citizens, not denying ...more
By peoplefirst (787), Southampton on Oct 22, 09 4:44 PM
Empire - get it - its "THEIR" financial empire no concern for consumers- arrogant and concerned only with profit...Drop Empire save your money
By lo-cal (77), southampton on Oct 22, 09 5:16 PM
if doctors and hospitals charge only for things they really did and don`t lie our premium be much lower
By patek13 (1), hampton bays on Oct 22, 09 5:27 PM
that would be fraud
By lo-cal (77), southampton on Oct 25, 09 5:56 PM
No if people didnt run to the doctor for every pimple on their butt....your premiums would be lower.
By squeaky (291), hampton bays on Oct 29, 09 10:40 AM
Even if national health insurance passes, it will take three years to implement, so there is no help in the short term there.

Wellpoint is a standard corporation whose effective management is measured by shareholder value. It is hard for some to realize that Blue Cross only shares the name of the non-profit that existed in our youth.

Since the impasse has gone on for this long, the likely reason is that Empire's reimbursement rate would bankrupt the Alliance which lacks the economies ...more
By highhatsize (4174), East Quogue on Oct 22, 09 6:13 PM
2 members liked this comment
Building a new hospital without a solid economic foundation for health care is just another expenditure that solves nothing. Economies of scale are not going to make health care affordable when private insurers post profits in the billions.

The only long term solution is to eliminate private health insurance. the 30% of premiums lost to profit and overhead (including advertising and lobbying), and the administrative expenses (over $30 billion annually) incurred by health care providers ...more
By Noah Way (450), Southampton on Oct 22, 09 10:33 PM
To Noah Way:

I do not disagree with you that including the insurance industry in national health care is vile. But that is another argument. The fact is that if national healthcare is passed it WILL be passed as a choice of insurances plan.

With that as a given, if the East End does not start planning an adquate facility now, it will never have the option of having a local general medical center. The inefficiency of the current three site system won't long survive an audit by ...more
By highhatsize (4174), East Quogue on Oct 22, 09 11:05 PM
Highhat, this reform is a stepping stone to Single Payer. If implemented properly, given a choice people will abandon their private insurance and we will finally join the ranks of all other industrialized, democratic nations and provide free health care for all as a basic right of citizenship.
By fcmcmann (417), Hampton Bays on Oct 23, 09 11:33 AM
Your argument is self-defeating. What we have now is the result of stupendously wealthy and politically powerful insurance companies that are exempt from anti-trust regulations. A new medical facility cannot be paid for when 1/3 of health insurance premiums go to profit and overhead.
By Noah Way (450), Southampton on Oct 23, 09 12:41 PM
That's silly. Our present system on the East End is the result of historical population patterns, not the insurance companies. New medial facilities are going to be built to accommodate the growing population and the new national health system. They will be paid for by tax dollars. The salient question here is WHERE they will be built.

By highhatsize (4174), East Quogue on Oct 23, 09 2:15 PM
Exactly why should health care be a basic right? Why should anything be a basic right? If you want healtcare you should work for it and pay for it youselves. You must be the typical liberal who thinks governments role is to give everything to you for free. Thats entitlement attitude is what has ruined this country. The argument that we should adopt socialized medicine because everyone else has is bogus. We have the best healtcare system in the world, for those who have earned it and paid ...more
By Walt (292), Southampton on Oct 25, 09 11:25 AM
It's very easy to picture an East End Hospital in Riverhead when you don't have to worry about the hour-plus drive to access that hospital coming from Orient Point or Montauk. Let's be realistic - Southampton and ELI are necessary centers, due to the isolation of the points on our island. Maybe Empire should just get over themselves, and think about the welfare of their customers, rather than the size of their wallets.
By LocalMom (36), Southampton on Nov 4, 09 7:19 AM
I would like to ask the hospitals who pays the bills for all of the illegals?... the same hospitals have a problem with the ins company not giving them more money. How about making these illegals pay there own bill and not have us or our ins companys make up the difference..
By tookatz (83), westhampton beach on Oct 23, 09 2:57 AM
1 member liked this comment
What does that have to do with this discussion. Firstly, the largest group of people using emergency services are American citizens. Families who have lost their jobs, single mothers, people who do not get insurance from work. You think Empire is paying for these people? Do you think your insurance company is paying for your neighbors who cannot afford insurance? They're not. You pay for it. I pay for it. The government pays for it and that is why we need health care reform not immigration ...more
By peoplefirst (787), Southampton on Oct 23, 09 8:15 AM
1 member liked this comment
There are far more Americans receiving primary care in emergency rooms than there are illegal aliens. We pay the bill for all of them one way or another. The insurance companies don't. They severely underpay hospitals, which accounts for the larger portion of SH hospital's budget problems and for rapidly rising medical costs as providers jack up their rates hoping to get reimbursed a meaningful portion of their costs.

The problem is NOT illegal aliens, it is insurance companies sucking ...more
By Noah Way (450), Southampton on Oct 23, 09 12:29 PM
1 member liked this comment
You are the one who needs to be educated. Stop listening to the Liberal media. Immigration policy is at fault for this country's problems. Not just the millions of illegals whose children flood our education system and health care system, but the quality of the immigrants who are legally has declined over the past 40 years. Immigrants used to have valuable trades when they came to this country. Now most have no skills.
By Walt (292), Southampton on Oct 25, 09 11:32 AM
My self and my fellow employees would be better off without Blue Cross insurance, but we are stuck with it. My employer and myself have been making payments to this company, and we receive very little in return. The three local hospital won't treat us except in an emergency and my personal physicial cannot admit me to any of these three hospitals. I intend to opt out of the medical plan at the end of the year. If I need a hospital I will go there and pretend I cannot speak the language of the ...more
By graibierd (6), Southampton on Oct 23, 09 7:37 AM
I agree with the comments by people first and noahs way. I think the insurance companies and for that matter the entire private sector as a whole are a bunch of crooks just trying to make a profit. I believe the GVT will do a far better job of managing our health care and will probabaly even make a profit for us tax payers. CBO estimates are always so precise and I'm confident that they are acurate. The GVT never runs overbudget and they do a very good job at managing our taxpayers dollars. I am ...more
By razza5350 (1911), East Hampton on Oct 23, 09 10:01 AM
Government is not particularly efficient, but it is far better than health insurance corporations that exist only to generate profit. Their ruthless efficiency kills 44,000 people every year and is responsible for 75% of all bankruptcies - and those people HAD insurance. Let's hope that you are not one of those.
By Noah Way (450), Southampton on Oct 23, 09 12:33 PM
Government exists only to redistribute wealth. Why doesn't your local gov't just raise the taxes on all those liberal hollywoof types that have moved to the Hamptons and ruined the area. I'm sure they won't mind, after all, they want the rest of us to pay.
By Walt (292), Southampton on Oct 25, 09 11:37 AM
Who was it who gave all those trillions of dollars in tax cuts to the "hollywolf types" in the first place? Or have you forgotten about the disaster named George W. Bush?
By peoplefirst (787), Southampton on Oct 25, 09 6:33 PM
Interesting discussion. Back to the immediate issue at hand, though. One of the difficult aspects of hospital/insurance company negotiations is that hospital costs are poorly understood, even by the hospital. To the extent that hospitals understand their costs, they do through a process known as "cost finding." Each year hospitals file a cost report to the state and to Blue Cross (or someone acting as a Medicare intermediary) which details their costs. That is fine as far as it goes, but cost finding ...more
By number19 (111), Westhampton on Oct 23, 09 11:46 AM
Right on, Number19!
By fcmcmann (417), Hampton Bays on Oct 23, 09 12:16 PM
The biggest problem with hospitals is that their entire operation is dictated by bean counters. This increases administrative costs, reduces money available for care and creates inefficiencies in the delivery of care to satisfy economic priorities.
By Noah Way (450), Southampton on Oct 23, 09 12:48 PM
Noah please get your facts straight and stop riding the Grayson train. I have seen the stat about bankruptcies for people with insurance as well. Its bogus. The major reason people need to file for bankruptcy is due to the fact they have no disability insurance. When you get sick you cant work and this leads to the inability to pay bills. Maybe we can the GVT to pay for our disability coverage as well. As far as the 44,000 number goes (lets throw out the fact that there are 300 million americans) ...more
By razza5350 (1911), East Hampton on Oct 23, 09 2:52 PM
@razza, you need to stop listening to Glenn Beck. Regurgitating his idiocy is an indication that your brain has atrophied.

You are wrong on all counts. People get sick, can't work, lose their jobs and then their health insurance. Then they go bankrupt. Or the insurer won't pay for care, forcing crippling expenses on the sick and their families. Medicare kicks in at such a low income level that there are millions who make too much to qualify but far too little to afford private insurance. ...more
Oct 23, 09 7:40 PM appended by Noah Way
medicaid, not medicare
By Noah Way (450), Southampton on Oct 23, 09 7:40 PM
empire is putting the customer me in the middle of there nightmare sending me the checks in my name and then having to foward to the hospital.what a pain in the #$$.this insurance sucks.now the hospital is calling me to see if i recieved the checks yet?WTF I'm going to start sending bills to the hospitals and insurance company for my time.
By asurest (117), easthampton on Oct 23, 09 8:16 PM
Dumped Empire - hello, Oxford!
By barnbabe (64), westhampton beach on Oct 23, 09 8:23 PM
noah you accuse me of being a fox clone you are wrong. left,right, conservative ,liberal. Stop listening to spoon fed information and do your own research and THINK for yourself. 1st of all its not medicare its medicaid. secondly insurance regulation is not controled by the federal GVT (at least not yet) but rather the states. NY state offers cobra and NY state continuation. They also offer subsidies for low income individuals called healthy NY. If you lose your job you have options
By razza5350 (1911), East Hampton on Oct 23, 09 10:29 PM
You sound like a Beck listener to me because you're spouting the same right-wing BS as him and Limbaugh. There are state insurance regulators, but they don't do anything because they are in the pockets of the insurance lobby. Have you paid any attention to the facts? Insurance rates have risen nearly 300% in just a few years while CEO execs make 27 million dollars a year and spend their money on lobbyists and denying claims. 44,000 people die every year for lack of coverage. 60% of ALL bankruptcies ...more
By peoplefirst (787), Southampton on Oct 24, 09 4:28 PM
1 member liked this comment
The majority of americans are fed up with liberal entitlement mongers like you. The next election cycle will show just how fed up the majority of amercians are over this socialistic health care reform being pushed down our throats.
By Walt (292), Southampton on Oct 25, 09 11:43 AM
Hey, Walter, perhaps you need to come up out from that rock you're living under and take a look around. A majority of American people SUPPORT health care reform WITH a government run public option and the republican party has the lowest approval ratings in the history of either party.

Glenn and Rush may tell you differently, Walter, but they're lying to you. As always, the right-wing neocons use the neediest and most ignorant members of our society to fight against their own best interests. ...more
By peoplefirst (787), Southampton on Oct 25, 09 6:30 PM
Judging from the posts it looks like all the negative ads run on Blue Cross by the hospital have been working. I'm no fan of Blue Cross but something tells me that the Hospital is not really looking out for our best interest either (as they claim). Its also a great negotiating tactic to bash the entity you are trying to negotiate with.
By razza5350 (1911), East Hampton on Oct 24, 09 9:08 AM
It is easy to blame insurance companies because the White House does and the liberal media falls in line with White House policies. Insurnace companies are to balme, as well as hospitals, doctors. lawyers (malpractive insurance). Health care reform should take smaller stesp in fixing these problems before socializing the entire system.
By Walt (292), Southampton on Oct 25, 09 11:46 AM
people first. You are smoking crack if you think a gvt run plan will offer better coverage at a better price. Just look at how bad Medicare is. They waste billions in fraud and have grossly underfunded liabilities. As for getting out of the way I would gladly if you told me I didnt have to pay higher taxes for people like you. If you look at history the GVT always have cost estimates that are way below actual cost. Can you please tell me when the GVT has actually come under budget. We are 10 trilllion ...more
By razza5350 (1911), East Hampton on Oct 24, 09 7:44 PM
Even on crack I make more sense than you. By the way, I think folks like you should be refused medicare when you come of age and I am sure you agree as that is a government run program.
By peoplefirst (787), Southampton on Oct 25, 09 6:21 PM
You can't argue with a rabid ideologue. razza has swallowed – hook line and sinker – the conservative / republican / Limbaugh / Beck line that government is the devil incarnate.

The ferocity of his beliefs blinds him to the simplest of truths: that this conservative republican ideology that government is bad started with a conservative republican, the great prevaricator himself, Ronald Reagan. There is no small irony that the man who said "Government is not the solution to our problems; ...more
By Noah Way (450), Southampton on Oct 24, 09 11:11 PM
You are oh so correct, Noah Way. Glad to see there are other sane people posting here every now and again.
By peoplefirst (787), Southampton on Oct 25, 09 9:35 AM
Forgot to mention, given your stance in most of your postings, I don't understand your animosity towards the Sag Harbor teachers?
By peoplefirst (787), Southampton on Oct 25, 09 9:40 AM
Great liberals like FDR, JFK, Lyndon Johnson, Jimmy Carter have led us down the path to entitlements. The New Deal was a Raw Deal. All the social service entitelements during the JFK.Johnson era furthered our permanent decline.
By Walt (292), Southampton on Oct 25, 09 11:49 AM
HAH! Revisionist
By peoplefirst (787), Southampton on Oct 25, 09 6:19 PM
wow. Noah take a chill pill and enjoy life. You are an angry person. Isnt dissent patriotic. Doesn't the ability to speak your mind and voice your opinion make this country great. Why is it people like you feel the need to force and impose their views upon all. Of course I believe you need the GVT for SOCIAL SERVICE programs. I do NOT believe we need the GVT invading the private sector. We are still a capitalist society (barely). The waste and mismanagement with our taxpayers dollars is staggering. ...more
By razza5350 (1911), East Hampton on Oct 25, 09 8:25 AM
I have seen few postings angrier than yours, Razza. And even fewer so filled with right-wing propaganda. You may call yourself a libertarian, but you sound just like a Limbaugh-tarian.
By peoplefirst (787), Southampton on Oct 25, 09 9:37 AM
No where else in the state does Empire have a problem with its compensation rates to hospitals. The Alliance Hispital Group are the real problem. They like to point the finger at Empire saying that they care more about profits than the patients. Look at Southampton Hospital. How mant of those doctors look like they are suffering from low wages? The Hospitals and Doctors are the problem, they won't accept less. If Obama passes health care reform, better go after all the greedy hospitals and ...more
By Walt (292), Southampton on Oct 25, 09 11:10 AM
But EVERY hospital (and doctor!) has a problem with insurance reimbursement rates. The payouts are so low that care providers have had to inflate their rates just to get any meaningful reimbursement. Insurers use escalating health care costs - costs that they are largely responsible for - as justification for raising premiums.

It is a vicious circle in which the consumer is crapped upon repeatedly while insurers pad their pockets (and those of their congressional stooges) with billions ...more
By Noah Way (450), Southampton on Oct 25, 09 11:37 AM
What happens if other insureres won't give the Alliance Group what they want? The only way to give the Aliance Group what they want is to raise premiums. Then you will all balme the insurance companies again. The costs of health insurance will not be truly addressed until hospitals and doctors have their rates fixed by the gov't. Obama belives that wall street companies and banks should have their salaries dictated by the gov't, what is wrong with doing the same to what will become a required ...more
By Walt (292), Southampton on Oct 25, 09 11:59 AM
That IS health care reform, Walt. If you followed the debate more closely you would know that one proposal is to cut rates paid to doctors and hospitals or to negotiate for lower rates, just like medicare. So, if you supported real reform you'd get exactly what you want.
By peoplefirst (787), Southampton on Oct 26, 09 10:46 AM
Trust me they can sugar coat it any way they want but the real left like People first and Noah want single payer universal care with coverage provided by the GVT. The public option is a step in that direction. We are closer than ever to having another huge entitlement that will cost us a fortune and eliminate choices for the type of coverage individuals want. Most people who have coverage like it. "If you have coverage and you like it you can keep it" is a load of crap. In the long run Doctors will ...more
By razza5350 (1911), East Hampton on Oct 26, 09 1:40 PM
... whereas doctors incomes are now dictated by private corporations, which are utterly devoid of fraud, except of course for obscene profits and denial of coverage and denial of payment for care. We're not talking about doctor's incomes, but if you want to then why are more and more doctors refusing to accept private insurance?

Get your facts straight, it was $92 million, not billion. Your information is wrong by a factor of 100. Likewise your $60 billion number is unsubstantiated. The ...more
By Noah Way (450), Southampton on Oct 26, 09 6:07 PM
1 member liked this comment
Health insured posted a whopping 2.2% profit margin last year. They rank 35th of 53 industries on the fortune 500.
By razza5350 (1911), East Hampton on Oct 26, 09 1:45 PM
That percentage represents billions of dollars and DOES NOT include the billions, that's right, billions with a "b" they paid to their CEO's and lobbyists. Razza, you have been completely brainwashed. No joke. Anyone who would stand up for the private health insurance industry is either and industry insider or completely out of touch.;
By peoplefirst (787), Southampton on Oct 26, 09 5:53 PM
I am no huge fan of the insurance companies and we need insurance reform but if I had my choice of insurance or GVT I would take the former. I believe in free market capitalism. As for being brainwashed look in the mirror.
Per Noah for more misinformation check out yahoo and click more news. Good article on healthcare wastes 800 billion a year yes billion. bullet points.
1. administrative inefficiency and paperwork account for 18% of health care waste
2. unneccesary care such as the ...more
By razza5350 (1911), East Hampton on Oct 26, 09 6:34 PM
First you said medicare fraud was $60 billion a year, now you say it is $200 billion a year. Can't make up your mind?

from your source: Healthcare system wastes up to $800 billion a year
http://news.yahoo.com/s/nm/20091026/hl_nm/us_usa_healthcare_waste

The other costs cited in that (single source) article in regard to health care costs, such as administrative inefficiency, redundant paperwork and unnecessary care to protect against malpractice exposure are the direct result ...more
By Noah Way (450), Southampton on Oct 26, 09 7:18 PM
Free market capitalism = banks, insurance companies and wall street screw every day Americans

1. That is addressed in the bill
2. That is addressed in the bill
3. That is addressed in the bill
4. Turn off fox and get educated
By peoplefirst (787), Southampton on Oct 26, 09 7:18 PM
un real. What do you do for a living. You either work for the Gvt, are unemployed and live off the gvt or make widgets for a living.
By razza5350 (1911), East Hampton on Oct 26, 09 7:25 PM
I am the CEO of a private insurance company.
By peoplefirst (787), Southampton on Oct 27, 09 8:24 AM
Noah you are not listening to what I'm saying or Im doing a bad job of explaining my position. I am FOR reform. I am FOR insurance reform. I am NOT for the public option and I have zero confidence in the gvt to run and manage our health care efficiently. With record deficits and spending this is another entiltment that we can afford. Unlike peoplefirst I respect your opinion but totally disagree
By razza5350 (1911), East Hampton on Oct 26, 09 7:31 PM
You don't want government health care (really government insurance) and that is your choice, but that doesn't give you the right to prevent others from having the ability make a different choice. You have zero confidence in government, I have zero confidence in corporations that are primarily (if not solely) concerned with profits - especially when the medical treatments I may receive have a direct effect on their bottom line.

You can spend you money on whatever you like: don't tell me ...more
By Noah Way (450), Southampton on Oct 26, 09 9:05 PM
I hear what your saying Noah but the problem is all of this is not going to be free. I can not spend my money anyway I want. The GVT will decide that for me. I dont have a problem if you want it as long as im not paying for it and we all know that can't happen. (I do favor subsidies for low income earners and temporary relief for unemployed)
By razza5350 (1911), East Hampton on Oct 26, 09 9:31 PM
I am a small business owner who must consider what is best for me, my family, AND my employees. I do not have the luxury of selfishness, like those of you who work in the corporate health care field. I don't have a company to pay my premiums, I do it myself. And I am not asking the government to do it for me either, I am asking the government to create compeition. After all, isn't that what capitalism is all about, competition? How can you be a free market capitalist and not support competition? ...more
By peoplefirst (787), Southampton on Oct 27, 09 8:37 AM
As of a few minutes ago, (Monday, October 26, 10:00 p.m), Sen. Harry Reid announced that the national health bill being sent to the senate floor will have a public option from which states may opt out. Sen. Olympia Snow expressed her disappointment. 60 votes are uncertain. (Does anyone else think that the agreement to change the Senate rules so that a majority became 60 instead of 51 in exchange for cloture being 60 instead of 66 is a bad idea and should be rescinded?)
By highhatsize (4174), East Quogue on Oct 26, 09 10:18 PM
Scratch that parenthetical. Research shows that the 60 vote cloture decrease actually decreased the number of votes necessary to allow a bill to be voted on in the Senate. It used to be 67. (Still is for Senate rules.) So, forty-one senators can prevent any bill from being voted on. Gee, if only the Democrats win seven more seats, maybe 51 votes will actually decide a bill.
By highhatsize (4174), East Quogue on Oct 26, 09 10:58 PM
Scratch that parenthetical. Research shows that the 60 vote cloture decrease actually decreased the number of votes necessary to allow a bill to be voted on in the Senate. It used to be 67. (Still is for Senate rules.) So, forty-one senators can prevent any bill from being voted on. Gee, if only the Democrats win seven more seats, maybe 51 votes will actually decide a bill.
By highhatsize (4174), East Quogue on Oct 26, 09 10:58 PM
Peoplefirst you are funny. You should be on the comedy channel.
By razza5350 (1911), East Hampton on Oct 27, 09 12:08 PM
You're funny too. You should be on FOX news.
By peoplefirst (787), Southampton on Oct 27, 09 2:59 PM
Personal story - happened over the past 3 weeks with Empire:

My young son has surgery scheduled for tomorrow. The procedure is covered under the plain language of my Empire PPO. 3 weeks ago I asked them to confirm coverage, citing the coverage language in the policy. Over the past 3 weeks they stalled, then claimed that there was a question over what the "policy intent" was. Despite the lack of any ambiguity in the plan language and my repeated demands, they continued to refuse to confirm ...more
By CoweeDewey (110), East Quogue on Oct 27, 09 3:13 PM
1 member liked this comment
Cowee, Thanks for your personal story. I am also astonished that people believe the insurance industry should be "protected". There is really no reason to even have insurance companies. They add nothing to our care and only serve as a middleman that adds unnecessary cost. Profit-driven private insurance is solely responsible for the sate of our health care in the US. It is why we spend more and get less than all other industrialized democracies.

The people that call for protecting ...more
By dagdavid (646), southampton on Oct 27, 09 8:59 PM
Oh People First. The evil fox news! (You believe that because Obama told you so.) I'm sure you get your info from MSNBC. You probably go to bed with a picture of Keith Obermann and George Soros.
Cowee I'm not sure what your situation was but seeing that you have a PPO I am assuming you wanted to go out of network for your surgery because in network the doctor would have precertified it. You do not have the option of going out of network with medicare. More doctors are opting out of medicare ...more
By razza5350 (1911), East Hampton on Oct 27, 09 3:31 PM
Spoken like a completely brainwashed and heartless insurance company shill.
By peoplefirst (787), Southampton on Oct 27, 09 8:51 PM
Razaa, I have read many of your postings on this issue and I have only one question for you: What value does private insurance add to our society?
By dagdavid (646), southampton on Oct 27, 09 9:07 PM
Fundamentalists (political or otherwise) such as razza are immune to reason and knowledge. Their world view is determined by their belief system. The only possible way for them to change is to willingly abandon their beliefs and seek wisdom - very the antithesis of belief.
Oct 27, 09 9:16 PM appended by Noah Way
whoops - the very antithesis of belief.
By Noah Way (450), Southampton on Oct 27, 09 9:16 PM
dag I DO beleive in reform. I believe we need to address the root of the problem which is the cost of care. I am also in favor of insurance reform, tort reform, providing subsidies for low income individuals, and temporary coverage for recently unemployed. I do not believe we have the infastructure in place to handle all of these changes at once and I feel we should implement them over time. I DO NOT favor GVT run Health care. If you feel it is our moral imperative to provide care for all americans(and ...more
By razza5350 (1911), East Hampton on Oct 27, 09 10:25 PM
My question is this: What value does private insurance add to our society? The clear answer is "none" - thy add no value. If you believe otherwise then tell us what value they add?
By dagdavid (646), southampton on Oct 28, 09 9:06 AM
Razza, I agree with you completely. There are people here that post on dozens of subjects, they think they are smarter than everyone else and know it all. Politics, health insurance, education, immigration (a really big one) they have all the facts and if you disagree you are a Fox lunatic and they collectively try to shut you up. What kind of crap is that to tell someone that they are immune to reason and knowledge and need to seek wisdom???? Well sorry, we're not all as high and mighty as ...more
By hamptons2009 (12), westhampton on Oct 27, 09 10:28 PM
You are already paying the bill for the uninsured and under-insured.
By dagdavid (646), southampton on Oct 28, 09 9:09 AM
It's interesting how Empire is not willing to pay the hospitals a higher reimbursement rate when they say that they will have to raise premiums. Since they can't raise premiums for their East End clients only, because of community rating, the increase would affect every one of their Groups in New York upon renewal. That means that the Groups on the East End of Long Island are paying for the higher reimbursement rates for hospitals west of us even though most of us don't use those hospitals. That's ...more
By bobalooey (45), East Quogue on Oct 28, 09 12:51 AM
I am not sure about profit hoarders. That is a myth perpetuated by the left and a great negotiating tactic used by the hospital. The average profit for health insurers last year was 2.2%. way below industry average. In fact many carriers such as MDNY and Vytra went belly up. I DO agree that it is BS that us eastenders get screwed again and pay the same premiums as nassau county yet the reimbursement is less. I also agree with you about Blue Cross claiming it would increase rates for all if they ...more
By razza5350 (1911), East Hampton on Oct 28, 09 8:56 AM
Actually, the hospital needs to make up for the low rate of reimbursement from insurance companies. It's right there in your own post. And this has nothing to do with "your local genius Tim Bishop" or "a myth perpetuated by the left". You are brainwashed, and your belief system makes you a blithering idiot.

FYI Empire is owned by Wellpoint. 2008 profits were $3.345 BILLION. Executive compensation in 2008 was over $80 MILLION.

But from where you sit that is probably good - they ...more
By Noah Way (450), Southampton on Oct 28, 09 9:51 AM
3.345 billion is a staggering number. How about 11 trillion what do you think of that number? And talking about our "honest" hard working politcians should I give you a laundry list of the billions of tax payers dollars our GVT has wasted on thier pet projects. Give me a break. Grow up
By razza5350 (1911), East Hampton on Oct 28, 09 10:10 AM
What value does private insurance add to our society?
By dagdavid (646), southampton on Oct 28, 09 10:16 AM
$3.345 billion is just one year's profit from one insurer that makes up your 2.2% "average profit for health insurers".

Just to make sure you get the point, YOU said industry profits are low. Your arguments are self-defeating, and would be laughable if they weren't so sadly ignorant. Typical FOXhole, regurgitating conservative talking points.

The real fraud is corporations raping the taxpayer and the treasury with the help of their congressional minions. WAKE UP. Socialism in ...more
By Noah Way (450), Southampton on Oct 28, 09 4:17 PM
What value does private health insurance add to our society? It provides financial protection in the event of a medical claim.
By razza5350 (1911), East Hampton on Oct 28, 09 1:08 PM
Not for the 45,000 who die each year because they don't have it. Not for those with insurance who are denied coverage. Not for those with insurance who go bankrupt to pay for medical care that insurance won't (62% of all bankruptcies filed in 2007 were linked to medical expenses). Not for the 50 million who don't have it. Not for the 100 million served by medicare, medicaid and the VHA.
By Noah Way (450), Southampton on Oct 28, 09 4:27 PM
We PAY for that financial protection, they do not provide it. And the only reason their is a "claim" in the first place is because we have for-profit, private insurance. Try again.
By peoplefirst (787), Southampton on Oct 30, 09 9:51 AM
Oh no here we go again. Quoting statistics by a bunch of researchers who are pro public option. I do not care if you are pro public option or against. Either side can come up with statistics that will support your arguement. FYI Less the gaps in coverage Medicare and VHA provide financial protection in the event of a medical claim as well but are operating at a huge loss to the taxpayers. adding deadbeats like Noah onto the plan will only drive the costs higher
By razza5350 (1911), East Hampton on Oct 28, 09 4:40 PM
Another biased Clinical Research Study by The American Journal of Medicine

"Medical Bankruptcy in the United States, 2007: Results of a National Study"

http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf

razza, if it doesn't fit into your belief system it is either a liberal plot or biased data. The only thing you've proven here is that you are an idiot. What's frightening is that there are others like you.
By Noah Way (450), Southampton on Oct 29, 09 12:10 AM
"There you go quoting facts again!" I know you guys hate to hear the truth, Razaa, but bitter medicine is often hard to swallow.
By fcmcmann (417), Hampton Bays on Oct 30, 09 5:55 PM
I was about to curl up on the sofa with my Glenn Beck book, picture of Dick Chaney and watch fox when I found my new best friend....Joe Lieberman. Speaking the truth
By razza5350 (1911), East Hampton on Oct 28, 09 6:54 PM
I'm not sure where you get your random 2007 archived information from (probably Politico) but my "idiotic" beliefs are based on cold hard facts. Our country is operating at a 1.6 trillion dollar defecit, our debt is 11 trillion and medicare has underfunded liabilities totalling in excess of 30 trillion. Medicare operates at a huge loss and now we are talking of adding on 30 million (you say 50) uninsured most of who cant pay for it. In a perfect utopian society we would offer coverarage for all ...more
By razza5350 (1911), East Hampton on Oct 29, 09 8:50 AM
You are not sure where I get information? Duh! Look at the posted links. Did you even bother to open it?

How much of that deficit is attributable to tax revenue lost to a collapsing economy due to deregulation that allowed CDOs, 40-1 leverage and a host of other things that allowed the financial sector to run rampant? How much is attributable to corporate welfare to AIG, Goldman Sachs and a host of others now busy paying out billions in bonuses for profits made on taxpayer money? How much ...more
By Noah Way (450), Southampton on Oct 29, 09 10:55 AM
Razza - Responding to your comments re: the story about my son:

First off, my family and I definitely have "Cadillac" PPO coverage through my employer, and the surgeon and hospital were both in network. The surgeon attempted to get pre-cert for the procedure but Empire refused to confirm coverage, and the surgeon said that my son needed the procedure asap - that's why were in the position we were in.

Regarding the coverage dispute - this was a textbook case of an insurer refusing ...more
By CoweeDewey (110), East Quogue on Oct 29, 09 12:13 PM
Cowee. Thank you for a well thought out and intelligent response. I do think it is important to note that if BLue cross were to deny your sons care (I hope he is well) than you would have had a financial recourse in the terms of appealing the decesion to the NY state insurance department or sueing. You do not have checks and balances when dealing with the GVT. You already answered the other question which is you do not care what it will cost as long as everyone is covered. I personnaly disagree ...more
By razza5350 (1911), East Hampton on Oct 29, 09 3:26 PM
Deficits only matter in health care. Deficits that reward financial corruption, pay for illegal and unnecessary wars, or fund trillion dollar tax cuts for the wealthy don't matter at all.
By Noah Way (450), Southampton on Oct 29, 09 5:04 PM
Noah, thats right I did not open the 2007 article posted on Move on.org written by Dr Kevorkian in 1997
By razza5350 (1911), East Hampton on Oct 29, 09 3:31 PM
LOL, this is how a brain-dead fundamentalist conservative describes a Clinical Research Study published in The American Journal of Medicine.

razza: Ignoring knowledge does not make you any less ignorant than you already are.
By Noah Way (450), Southampton on Oct 29, 09 5:00 PM
Cowee, FYI Blue Cross NY denied 6.2% of claims last year. Medicare denies 6.85%. California is by far the worst with denials running up to 30%. Must be something in the air or denials for plastic surgery like Pelosi's face lifts
By razza5350 (1911), East Hampton on Oct 29, 09 3:39 PM
Noah most of us don't have time to look all of these things up because we have to work at are real jobs so we can keep paying for all of these entitlements but out of curiousity I did check it out.Again the statistics were misleading because they include bankruptcy due to illnus. If you get sick and cant work you have no income. If you have no disability insurance you cant pay your bills. Your illness is an indirect reason for you having to file bankruptcy but the direct reason is the fact most ...more
By razza5350 (1911), East Hampton on Oct 29, 09 6:23 PM
Bankruptcy due to illness is exactly what we are talking about. It is called MEDICAL BANKRUPTCY. There is nothing misleading about it. The only thing misleading is your desperate attempt to vilify any form of public insurance.
By Noah Way (450), Southampton on Oct 29, 09 9:25 PM
1. The study was conducted by Dr David Himmelstein an associate professor at Harvard and co founder of physicians for a national health plan He is the leader in the movement for universal health care. So I would say his clinical research may be somewhat biased
2. Bankruptcy due to illness is open to interpretation. If you have NO disability insurance you will go bankrupt due to illness
By razza5350 (1911), East Hampton on Oct 29, 09 10:41 PM
Now there is a strong argument: a medical doctor's scientific research is invalidated by your opinion. Anything you don't agree with is biased - why am I not surprised? The reflection of that is both illuminating and hilarious, although I doubt it is visible to you.

Disability insurance is no panacea. It takes 6-12 months to kick in. it only pays a portion of income, generally around 1/2, which for most would not be anywhere near enough to sustain basic living expenses let alone luxuries ...more
By Noah Way (450), Southampton on Oct 30, 09 12:30 PM
One thing I don't get is the prexisting condition part of the reform bill. IF you are going to cover all prexisting conditions with NO wait the GVT needs to do more to force coverage upon people. If they don't healthy people will opt out pay the small fine and just jump on when they get sick. I favor a stiffer penalty if they opt out or better yet do what NY state does and deny coverage for prexisting coverage for 1 year if you do not have it
By razza5350 (1911), East Hampton on Oct 30, 09 7:57 AM
1. Noah you are incorrect. I have disability insurance. It kicks in after 90 days and pays me a TAX FREE benefit of@65% of my income to age 65
2. I never said Science and logic had no meaning but when the person conducting the study has an agenda and the data is not clearly defined than in my opinion it is not science
YOU need to follow your own advice and seek answers and information from other sources besides moveon.org
By razza5350 (1911), East Hampton on Oct 30, 09 1:46 PM
Razaa is such a typical teabagger! They are so anti-intellectual. Hey, Razaa, brains mean something. The ability to think creatively and intelligently means something. It is worth something. I know you don't want to let those pesky, little facts get in the way and that you can't wait to write-off any study as some kind of left wing, liberal conspiracy, but to embrace stupidity just makes no sense. Sorry to interrupt your Beck watching time.
By fcmcmann (417), Hampton Bays on Oct 30, 09 6:00 PM
Razza - regarding the seemingly low rate of denials, I'm personally convinced that, instead of denying coverage, the general practice is instead to refuse to confirm coverage without giving an outright denial. Although the net result is the same (the insured is left thinking there won't be coverage), the insurer gets to avoid bad faith claims and also keeps its denial stats low.

Unfortunately we'll likely never know what percentage of insureds who can't get a confirmation of coverage ...more
By CoweeDewey (110), East Quogue on Oct 30, 09 6:04 PM
Cowee, It sounds like you had a bad experience and I do not blame you for having reservations. I believe your points may have merit when talking about small claims but I'm pretty sure those denial statitics are pretty valid for larger claims. People are not going to abandon a larger size claim. This is not a John Grishom book or the movie Sicko. Even if you do believe that people give up Medicare has the same denial rate so what makes you think the GVT is any different
By razza5350 (1911), East Hampton on Oct 30, 09 7:01 PM
fcmc that was a very well thought out post. You made some great points. Please make sure to bless us with your genius more often.
By razza5350 (1911), East Hampton on Oct 30, 09 7:03 PM
1 member liked this comment
Kind of like looking in a mirror, isn't it?
By Noah Way (450), Southampton on Oct 31, 09 5:28 PM
Have the hospitals or Empire disclosed the payment and reimbursement rates of other insurers? That would be most helpful to know. . .why don't the representatives get that information from other insurers and then take a good look at the respective positions of Empire and the Hospital?

I suspect that Empire IS "lowballing" as no other insurers are pulling the same stunt, but it would be quite easy to find out by getting that information. Does anyone know if this is occurring on a nationwide ...more
By lulubelle1956 (24), Westhampton Beach on Nov 4, 09 8:59 PM
Lulbelle, Ny state has intervened and they have been meeting with mediators. The hospital does not want to cave in and give other carriers leverage when there contracts come up. I'm curious to see how they will handle Oxford (the other major carrier out here) when their contract is up for renewal. Blue Cross continues to charge us Nassau county rates yet reimbure the doctors and hopitals below par. Both sides should be embarrassed.
FYI you can still get the basic care you are paying for. All ...more
By razza5350 (1911), East Hampton on Nov 5, 09 10:43 AM
AARP (association AGAINST retired people) endorses the health care reform bill. Almost laughable! If the public option comes even close to resembling Medicare they stand to make billions through their medigap policies. AARP is the biggest scam on seniors. Orginally created as a means of providing information to seniors they have morphed into a giant conglomorate whose business tactics resemble the gestapo. Not sure how they can endorse something without the support of all its members.
By razza5350 (1911), East Hampton on Nov 5, 09 7:35 PM
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