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Sep 29, 2009 5:40 PMPublication: The East Hampton Press

LaValle calls for State Senate hearing on Empire negotiations

Sep 29, 2009 5:40 PM

State Senator Kenneth P. LaValle said Tuesday he is calling for the State Senate’s Insurance Committee to hold a hearing in November to investigate the business practices of Empire Blue Cross Blue Shield.

The senator’s actions came as Empire and the East End Health Alliance entered a 10th week of contract negotiations without an agreement. Alliance hospitals—Southampton Hospital, Eastern Long Island Hospital in Greenport, and Peconic Bay Medical Center in Riverhead—went out of Empire’s network on August 1 as they failed to reach settlements on most of its health insurance plans.

Negotiations center on how much money Empire pays the hospitals to treat Empire subscribers. Alliance claims Empire must raise its reimbursement rates because it pays so little that hospitals lose money treating Empire patients. Empire says that raising the rates would result in higher premiums for Empire subscribers.

Nonetheless, Mr. LaValle expressed concern that negotiations have stalled and that Empire has been “treating the East End hospitals unfairly.”

“[Negotiations] have broken down and, quite honestly, I think our three hospitals have been treated shabbily,” he said.

Mr. LaValle said also that State Supervisor of Insurance James J. Wrynn has “not taken an aggressive position” to resolve the contract impasse. He said the committee may need to consider legislation to protect hospitals from the whims of large insurance companies.

“I believe that they are the largest provider of health insurance in Suffolk County, so that they have a monopoly,” Mr. LaValle said. “They need some oversight.”

Mr. Wrynn’s offices in Manhattan have been a meeting place for Empire and Alliance negotiation teams to discuss reimbursement rates.

Mr. Wrynn was not immediately available for comment.

“Making nice, playing by the rules, doesn’t work with these companies,” Mr. LaValle said. “And, from my point of view, I don’t mind throwing them up against the wall so that they play fair and seek an equitable accommodation with the three East End hospitals.”

Alliance spokesman Paul Connor III said the board of trustees for the Alliance is expected to review a proposal from Empire at a closed-door meeting on Thursday. He declined to comment on the proposal and the negotiations, citing a “quiet period” that both sides agreed on in order to focus on reaching an settlement. A spokesman for Empire also declined to comment on the negotiations.

Still, it is unclear whether a settlement will be reached anytime soon, Mr. Connor said.

“We’ll see what happens on Thursday,” Mr. Connor said. “I am always hopeful. I am eternally hopeful.”

State Senator Neil David Breslin, chairman of the Senate’s Insurance Committee, did not return a call for comment.

At least 40 percent of patients within the Alliance coverage area subscribe to Empire. Thousands of Empire subscribers have been impacted since the three East End hospitals went out of Empire’s network. Though both sides last month reached a settlement on Empire’s Mediblue plan for seniors, other Empire plans have not been accepted at hospitals except in cases of emergencies and preapproved procedures and treatments.

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It is rediculous that Sen. LaValle wants to wait until November to hold a hearing. This should be one of the issues that the State Senate Insurance Committee takes up immediately. This issue has been going on with the East End Health Alliance since March or May of this year. The negotiations have gone nowhere and 40% of us that are insured by Empire BC/BS can't use the local hospitals. I find it disgusting that we are paying such high premiums for coverage that we don't have access to. It is ...more
By bobalooey (45), East Quogue on Oct 3, 09 11:20 AM
oh yeah and what do you propose to sue over? How about changing to another carrier if you are so disatisfied
By razza5350 (1911), East Hampton on Oct 3, 09 9:36 PM
Empire is being ridiculous, their reimbursement scale is pathetic and now they are sending funds to the patients instead of the Hospitals so that there is even longer delay for the money to go these institutions. Empire is arrogantly using its billions to financially pinch pracitioners, hospitals and patients. And people are scared of a government option? I don't know anyone on medicare thats complaining about their coverage. Don't wait sue ' em and get Cuomo on the job asap ! It's extortion!
By lo-cal (78), southampton on Oct 4, 09 3:40 PM
And the hearing is when? Would these representatives please get reimbursement/payment rates from other insurers on LI and Medicaid/Medicare to use on a comparative basis?I hope they are doing their homework. . . .Time to use that subpoena power!
By lulubelle1956 (24), Westhampton Beach on Nov 4, 09 9:01 PM