July 7, 2009
Empire Blue Cross Negotiation Update:
The East End Health Alliance hospitals – Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital – continue to negotiate with Empire Blue Cross to renew their provider agreements.
Please refer your insured parties to the FAQs at www.HealLI.com or to the Alliance Hotline at 726-FACT (3-2-2-8) to assist in answering questions that may arise in the event a contract resolution is not reached with Empire Blue Cross by August 1st.
This negotiation is critical to the three hospitals financial health for the following reasons:
- Empire Blue Cross accounts for the highest percentage of commercial insurance business at all three hospitals;
- Empire Blue Cross rates are significantly lower than those rates paid to the Alliance hospitals by the other commercial payers., third party payers, insurance companies, etc.
- The Alliance hospitals are, we believe, reimbursed at a significantly lower rate than other hospitals in Nassau and Suffolk by Empire Blue Cross.
The rate request on the table is our ‘market rate’, the reimbursement rate paid to the Alliance hospitals by other commercial insurance payers.
It is important to note that while Empire Blue Cross has been able to pay your healthcare providers significantly less than their competitors, the Empire Blue Cross premium charged to regional employers is not lower. In fact, Blue Cross has passed on significant premium increases to employers over the past two years.
Despite the severe economic woes that have plagued the U.S. and world economies for the past 18 months, WellPoint, the parent company of Empire Blue Cross, reported net income of $2.5 billion in 2008. In comparison, the East End Alliance hospitals have losses from operations in excess of $10 million for 2008.
While we remain committed to successfully completing our negotiations with Empire Blue Cross prior to the contract expiration date, there is the possibility that Empire Blue Cross will not agree to acceptable rates. In this event, the hospitals will be forced to go “out of network”.
Please understand that while this may impact the scheduling of elective procedures; it will not impact access through the emergency room for urgent and/or emergent care, including any admission that may result.
Thank you for your assistance in bringing this information to the attention of all interested parties and stakeholders, i.e. employees, brokers, agents, insured, Blue Cross clients, etc.
Link to FAQs below:
http://healli.org/bluecross-faq.html
