Empire Blue Cross--any issues?

[Snazzy]

They are dropping several Westchester hospitals in April (Lawrence Hospital, Northern Westchester Hospital, Phelps and White Plains Hospital), and today I also had a family member denied a drug she had been prescribed and covered-for over the last 10 years or so. Same person was about to have surgery at Lawrence.

Anybody have incidents?

Talking to media come Monday so more info = more better. No media coverage that I've seen (well, WSJ had blurb, below).

Assumption is that this has something to do with preempting health bill changes.

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http://online.wsj.com/article/SB10001424052748704059004575128002799146506.html?mod=WSJ_hpp_sections_business

> In a fresh battle, Stellaris Health Network, a four-hospital system in Westchester County, N.Y., just asked a unit of health insurer WellPoint Inc. to increase its payments by 16% this year—in part, so that Stellaris could fund a new cancer center, according to the insurer.
>
> The hospital's contract is set to expire at the end of the month, and WellPoint's Empire BlueCross BlueShield unit is pushing back. It sent letters to members on March 2 warning them that the insurer might lose the hospitals from its network.

[Snazzy]

1. update since Google grabs this

No luck getting a return email from journal news. Have written both Lower Westchester health reporter and the managing editor. Since people will actually lose coverage this week, maybe someone will notice and cover it.

Apparently same sort of thing in LI (but the local media covered it, and they are making a deal):

Hospitals Near Empire Deal

By Jennifer Landes

(03/25/2010) Sources close to the contract negotiations between the three hospitals that make up the East End Health Alliance and Empire Blue Cross Blue Shield said this week that an agreement could be finalized in days and that the two sides were closer than they had ever been in the negotiations.

The chief executive officers of South­ampton Hospital, Eastern Long Island Hospital in Greenport, and Peconic Bay Medical Center in Riverhead, met yesterday morning with their chief financial officers, who are taking the lead in the negotiations.

The hospitals have been without a contract since August, and residents of the South Fork who have Empire coverage have faced uncertainty about what is and what is not covered at Southampton Hospital. Emergency care is covered, but routine testing is not. The alliance hospitals, however, have said they will only charge patients what they would have been responsible for had they been in Empire’s network.

...

http://www.easthamptonstar.com/dnn/Home/News/HospitalsNearEmpireDeal/tabid/11660/Default.aspx

[TreasonousBastard]

2. This has been ongoing for close to a year, and has nothing to do with the new law...

there are few details being let out, but the East End Health Alliance is demanding an increase from BCBS and BCBS is demanding a fee reduction from EEHA. Both sides claim they are being screwed-- the hospitals say they are getting paid less than other Long Island hospitals, and the insurer says that's not true and they are paying too much.

But, nobody is telling us who's paying what.

So, BCBS tossed the three hospitals out of their network, leaving everyone out here without hosptial coverage if they have BCBS. There are no other hospitals out here, and the next closest one is maybe 50 miles away.

Now, it's easy to immediately blame nasty old Blue Cross for the mess, but I have been to fundraisers for two of these hospitals and they have been completely rebuilt and modernized at great expense. Not that it wasn't needed, but they are out on a limb financially and don't deny that they just might have been trying to hold up Blue Cross for a big chunk of their expenses upgrading the facilities.

Either way, it sucks for the Blue Cross insureds, who are caught in the middle.

On edit...

My mother has Blue Cross Blue Shield in addition to Medicare, and has had no problems at all with them. She lives on another part of Long Island and uses one of those hospitals 50 miles away from here.

[Snazzy]

3. Thanks for the info Treasonous

Sounds very similar to what is going on here.

The hard ball negotiating does indeed suck for the people in the communities affected. Elderly especially, who get cut-off from the very hospitals that may have been a deciding factor in where they reside into retirement.

Looking for trends. As you say this may not be directly related to the HCR bill (at least in LI), however it speaks to some reform that was and is needed.

[Snazzy]

4. Press release today from Stellaris

Community Hospital Group Contract Expires With Major Health Plan Insurer


Stellaris Health Network Says Empire Blue Cross Puts Stockholders Ahead of Community Healthcare

As Other Health Insurers Renew Contracts, Empire Refuses to Pay Competitive Rates

ARMONK, N.Y., April 1 /PRNewswire/ -- Stellaris Health Network said today that its contract with Empire Blue Cross Blue Shield expired at midnight March 31st ending a long-standing relationship with the prominent health insurance provider that is owned by WellPoint Inc., one of the nation's largest health insurance conglomerates. The expiration follows several months of unsuccessful efforts to reach a new agreement giving the hospitals reimbursement rates that are consistent with those being paid by other health insurers in the market.

Thousands of Empire subscribers who use the four Stellaris hospitals are affected. The Stellaris members are: Lawrence Hospital Center (Bronxville), Northern Westchester Hospital (Mount Kisco), Phelps Memorial Hospital Center (Sleepy Hollow), and White Plains Hospital Center (White Plains).

"Our non-profit community hospitals can no longer subsidize the record profits of a health insurance conglomerate, and that is what Empire expects us to do," said Arthur A. Nizza, President and CEO of Stellaris Health Network. "Our hospitals are committed to providing quality medical services to the communities we serve. However, that commitment cannot be met if we are forced to accept reimbursement rates that are far below the cost of providing the services."

Nizza continued: "As the recent enactment of federal healthcare legislation made clear, the era of health insurance companies running roughshod over hospitals and patients in their unbridled quest to reap huge profits for their investors is over. Apparently, Empire and its parent company, WellPoint, have not yet gotten the message. For the health of our nation and our communities, the time has come for the insurance conglomerates to join with the hospitals and healthcare community to invest in our healthcare system and not just bleed the system to gain record profits for their investors."

Nizza said Stellaris Hospitals have not asked Empire for reimbursement increases that are any greater than what they already receive from other insurers in the market. In order to maintain their position in providing high-quality health services, Stellaris Hospitals need an adequate revenue base. In the past six months, Stellaris Hospitals have reached renewal agreements with two national and two regional insurance companies. Empire has stood alone in its refusal to agree to reimbursement rates that are even close to those that other insurance companies in the market are paying.

As hospitals and physicians struggle, Empire Blue Cross Blue Shields' parent company, WellPoint, Inc., continues to report record revenues and profits. For 2009, WellPoint's total revenues were $61 billion with net income of $4.7 billion, nearly double its 2008 results. This is the same WellPoint that was recently criticized by a Congressional committee for raising rates by as much as 39% for individual insurance plans in California. The Congressional committee also rebuked WellPoint for raising rates for subscribers while spending millions on lavish corporate retreats.

"While the insurance conglomerates such as WellPoint raise insurance premiums and provide inadequate reimbursement to providers to maintain their bloated profits for their investors, Stellaris Hospitals have invested over $100 million in the last several years alone for new facilities and state-of-the-art technologies," Nizza said. "Our commitment is to our patients and the communities we serve, not to shareholders or Wall Street analysts. Insurers such as Empire need to recognize that sufficient reimbursement rates are necessary in order to sustain the fiscal well-being of health care in New York. Our network simply cannot accept inadequate reimbursement and still meet our commitment to provide quality medical services."

Over the past several years, Stellaris Hospitals have received national recognition for their implementation of information technology to improve patient safety and quality of care. Nizza concluded: "We have ongoing efforts to make our hospitals more efficient and cost effective. We do our part to reduce waste and unnecessary cost. At the end of the day, whatever expenses we reduce or additional reimbursements we receive stay local. Our financial viability enables the doctors, nurses, social workers and therapists to provide the high quality care our communities deserves."

Stellaris has established a Helpline – 1-888-838-3187 – to assist patients with questions about the Empire Blue Cross Blue Shield contract expiration.

SOURCE Stellaris Health Network

http://www.prnewswire.com/news-releases/community-hospital-group-contract-expires-with-major-health-plan-insurer-89682987.html