Area hospitals reach deal with Aetna insurance
Talks with Empire progress
1 comments below
Six months into its unresolved contract talks with Empire Blue Cross Blue Shield, the East End Health Alliance announced a settlement Monday with Aetna.
The agreement "renews the current contract" and keeps Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital in Aetna's network for both commercial and Medicare coverage, according to a press release from alliance spokesman Andrew Mitchell, PBMC's president and CEO. Physicians at each of the hospitals are included in the settlement.
Details won't be made public, but the new pact with the alliance replaces individual agreements the three hospitals had with Aetna. It will continue through the end of 2010, said Paul Connor III, ELIH president and CEO and the alliance's spokesman for managed care contract issues.
He said relatively few people in the area are covered by Aetna; Empire and Oxford/UnitedHealthcare cover more. He did not indicate when Aetna's last contract expired.
Given the protracted talks with Empire, some patients wondered if other insurers might play hard ball in negotiations with the alliance. Aetna was the first up at bat since the Empire impasse developed. Talks with Aetna have been going on for several months. Both sides had agreed to an extension of the old contract until a new agreement could be signed.
Mr. Connor said he had begun preliminary talks with Oxford/UnitedHealthcare, whose contract expires in July. He expects serious negotiations to start shortly. Empire's contract expired July 31 and the area's hospitals are accepting only emergency Empire patients and some others under limited circumstances.
"I'm very encouraged that they are close," Rep. Tim Bishop (D-Southampton) told Times/Review Newspapers Tuesday. He has been a driving force in keeping both sides talking. "Our constituents are the same," Mr. Bishop said.
"I think it would be devastating if they cannot reach a settlement," he added.
At the outset, Empire spokesman Craig Andrews said the alliance was asking for a 60 percent increase in reimbursements. That kind of increase would require too big an increase in premiums for Empire's customers, he said.
Mr. Connor argued that Empire was paying much lower rates for procedures than other insurers and the hospitals couldn't afford to continue to treat patients for such low reimbursements.
The only major breakthrough in talks between alliance representatives and the insurers occurred late in August when a settlement was reached enabling seniors on Medicare, who have an Empire MediBlue wraparound policy, to be covered for treatment at the three hospitals.
Following a couple of recent late-night meetings, the alliance put an offer on the table, followed by a counteroffer from Empire that the hospitals are studying.
Talks have been on and off during the past several months, with both sides sometimes agreeing to blackouts on public statements and other times making statements about how far apart they were. But both have been quiet lately, breaking the silence only now with the word that the impasse could be nearing an end.
Patients have been able to access emergency care at any of the three out-of-network hospitals, but were forced either to delay elective procedures and lab tests or to go to other, more distant hospitals for treatment.
Women in the second or third trimester of pregnancies as of Aug. 1 also are treated through to the deliveries of their babies at alliance hospitals, with Empire picking up the tab based on reimbursements under the former contract.
In early August, alliance hospitals said they wouldn't pursue collections of out-of-network costs beyond what patients with out-of-network benefits would have to pay. But patients still remain responsible for deductible payments under the terms of their insurance policies. The only exception was for people whose policies include out-of-network services administered by Empire.
jlane@timesreview.com
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1 comments found
What Empire's Problem?? : 2/4/2010
If Aetna and the Alliance can agree on reasonable terms, without ever go out of network, pleae tell me what Empire's problem is? I own a small business on the East End. My renewal with Empire is next month. I'm ditching Empire to go with Oxford or Aetna.
