January 28, 2013
Status of Contract Negotiations with East End Health Alliance
Empire BlueCross BlueShield is currently in negotiations with East End Health Alliance* (EEHA) for a new multiyear agreement effective March 1, 2013. EEHA consists of Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital. Contract negotiations with our participating providers are a standard part of what we do every day to bring you access to a broad network of providers.
Fortunately, we successfully conclude most of these negotiations. Empire and EEHA have a long history of partnership and we recognize the importance of this hospital to you and your family. For these reasons, we have worked hard to develop a fair proposal to support the system's ongoing needs including reasonable annual increases that more than cover normal hospital operating cost inflation.
We are informing you of this negotiation because EEHA's contract with Empire is scheduled to terminate effective February 28, 2013. This means that EEHA will be considered an out-of-network for dates of service on or after March 1, 2013. We certainly hope that a reasonable agreement on your behalf would be completed before February 28, 2013. Based on history, despite occasional news media coverage, actual terminations of hospital contracts rarely occur and have always been resolved within a relatively short period of time when they do terminate.
The reason Empire negotiates provider contracts is simple — to provide you with a broad network of providers who have agreed to accept negotiated rates and other important contract terms (such as terms that prohibit the provider from balance billing, you, our member). This makes premiums more affordable and lowers your out-of-pocket expense. Depending on the type of coverage you have, 80 to 90 percent of your Empire health coverage costs are healthcare provider costs. Almost half of those costs are hospital
costs. Any unreasonable increase can impact both the overall insurance rates in your community, and for plans that have deductibles or coinsurance, it could increase your out-of-pocket costs.
Again, we wish to assure you that Empire is working diligently, and in good faith, to reach a reasonable agreement with EEHA on your behalf by February 28, 2013. Attached is a list of common questions you may have about what happens when a negotiation takes longer than intended, and a special number you can call if you have additional questions. Empire will provide you with further notice and details if we
believe an agreement with EEHA is unlikely before the contract expires. Please visit our website at www.empireblue.com for updates.
Vice President, Provider Engagement & Contracting — NY
QUESTIONS THAT MAY ARISE IF CONTRACT NEGOTIATIONS
ARE NOT COMPLETED BY FEBRUARY 28, 2013
If an agreement is not reached before March 1, 2013, will I be covered if I receive emergency care services at EEHA?
Yes. In all instances, emergency services at any appropriate facility or hospital, including EEHA will continue to be covered in accordance with member benefit contracts and governing state and federal laws. However, you may be transferred to an in-network hospital once your condition stabilizes. It is also important to understand that there will be no immediate interruption of care that is already underway at EEHA.
What if I am scheduled for a procedure or need to seek care at EEHA before March 1, 2013? You will continue to have access to EEHA for covered services on an in-network basis through
February 28, 2013. It is important to again note that emergency services will continue to be covered on an in-network basis at any hospital, including EEHA, after February 28, 2013.
What if I am scheduled for a procedure at EEHA after February 28, 2013?
Except for maternity care services and continuity of care services, as described below, for any inpatient or outpatient surgeries or procedures that you may have scheduled at EEHA on or after March 1, 2013, unless authorized in advance by Empire, it will be necessary for your provider to relocate those surgeries or procedures to another hospital or facility that participates with Empire, or refer you to another provider who can render the care at a hospital or facility that participates with Empire. This will ensure that those services are covered at the highest possible level of benefit.
What if I am pregnant, can I receive maternity care services at EEHA?
Yes. If you are in your second or third trimester of pregnancy as of February 28, 2013, you may be eligible to receive what is known as continuity of care in accordance with the terms of your benefit plan through the delivery of your child and post-partum care directly related to the delivery, so long as EEHA agrees to continue to render services under the same terms as those specified under the most recent agreement between EEHA and Empire.
What if I am not pregnant and I am currently receiving services at EEHA as of March 1, 2013, will my care be interrupted?
No. If you are currently receiving services at EEHA and you are in an ongoing course of treatment, you may be entitled to receive continuity of care in accordance with the terms of your benefit plan at EEHA for a period of up to 90 days ending on May 29, 2013. Approval of covered services during this transitional period is conditioned upon EEHA's agreement to provide services according to the terms of the most recent agreement between EEHA and Empire.
Though we have generally been successful in the past reaching an agreement with our hospitals, if an agreement cannot be reached, we will work closely with you to ensure your future care is not compromised. Towards this end, we want to assure you that you will continue to enjoy access to a large list of nearby hospitals. For your own reference, attached is a list of alternate area hospitals currently in our network
Again, we are hopeful and working hard to come to a resolution. Please note if an agreement is not reached with EEHA by February 28, 2013, your relationship with a physician with exclusive admitting privileges at EEHA may be impacted, and a subsequent letter will follow with further information concerning selecting a new physician.
If you have any questions beyond the information that is provided in this letter, we have arranged for a dedicated call line to be available to provide you with additional details. Members should call
(800) 495-9323 Monday through Sunday from 7:00 a.m. through 8:00 p.m. (EST). Please visit our website at empireblue.com for updates.