Tag Archives: Empire Blue Cross

New York Presbyterian and Empire extend contract

From Anthem Health:

 

New York-Presbyterian and Empire BlueCross BlueShield have agreed to a multiyear deal to keep the 10-hospital health system in Empire’s network. The accord ends a public fight that stoked fears that about 300,000 NYP patients would face higher out-of-network charges next year.

The agreement will also maintain Empire members’ access to New York-Presbyterian’s medical groups, including Columbia Doctors and Weill Cornell Medicines. Their current agreement was set to expire on Dec. 31 and covered people in employer-sponsored, individual, Medicare and Medicaid plans.

A spokesman for NYP declined to disclose further details of the contract. The typically private nature of managed care negotiations spilled out into the open last week when the City Council scrutinized New York-Presbyterian’s prices.

“We are pleased that this agreement will allow patients to continue to choose to receive care from NewYork-Presbyterian and its affiliated physicians,” both sides said in a joint statement.

The union 32BJ, one of the city’s most politically active unions, whose membership includes cleaners, doormen and security guards, complained at a City Council hearing last week about the cost of care at NYP compared with other city hospitals. The union uses Empire to build its network.

NYP and Empire had struggled to agree on appropriate payment rates. Self-funded clients, such as 32BJ, had pushed Empire to negotiate better rates on services. The union made public that for 13 hip replacements it had paid the health system nearly $83,000 on average, more than $25,000 above what other city facilities charged. For vaginal deliveries, the union paid nearly $24,000—about $7,000 more than its average at other city hospitals.

New York-Presbyterian said a potential $200 million cut in reimbursement would have threatened its ability to invest in patient care and support the training of future physicians.

If the two sides had not reached a deal, NYP stood to lose a major source of patients, while Empire faced the prospect of selling policies without U.S. News’ top-rated New York hospital in its network. New York-Presbyterian had begun advising patients to consider other insurers on a website set up to notify them that its contract with Empire was set to expire.

Empire Blue Cross terminates South Nassau Community Hospital

From Empire Blue Cross: “We are actively negotiating a renewal deal but we have reached a point where we are proceeding with the activities to terminate our contract effective 5/1/18.  The 60 day cooling off period ends 7/1/18 , on 5/15/18 notification letters were mailed to our members. As always we are continuing our dialogue with the facility in the hopes of reaching a mutually acceptable agreement.”

Therefore as of 7/1, at the end of the cooling off period, if no deal has been reached, South Nassau will be out of the network.

 

Major Changes to NY Empire and Oxford plans for 2017

logos for blue cross and oxford

Empire Blue Cross Network Changes-

  1. EPO/PPO (i.e. “BlueCard”) –this is Empire’s best-in-class legacy BlueCard network
  2. Blue Priority – full BlueCard hospital network with a narrowed practitioner (doctor) network when in Empire’s 28-county service area. Plans are non-gated with National BlueCard access for folks living and traveling outside of NY.  Most of Northwell doctors now are non-participating in the Blue Priority Network.  Doctors were just notified in November. The change does not impact BlueCard and/or Pathway networks – Northwell doctors and hospitals still participate in both of those.
  3. Pathway – narrowed hospital and practitioner network limited to Empire’s 28-county service area (though this network has grown to be fairly comprehensive, missing really only Memorial Sloan Kettering & SUNY Stonybrook)

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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