After six months of contract negotiations between Armonk-based Stellaris Health Network and Empire BlueCross BlueShield, four Westchester County hospitals are now out-of-network providers.
The hospitals include White Plains Hospital Center, Northern Westchester Hospital in Mount Kisco, Phelps Memorial Hospital Center in Sleepy Hollow and Lawrence Hospital Center in Bronxville.
Empire BlueCross BlueShield said Stellaris demanded annual double-digit rate reimbursement increases; Empire spokeswoman Sally Kweskin said the number was 15 percent.
“While the insurance conglomerates such as WellPoint (Empire”™s parent company) 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,” said Arthur Nizza, Stellaris president and CEO, in announcing the contract termination.
“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.”
Patients are still eligible for coverage when treated in emergency departments or when admitted through EDs, according to a letter addressed to Stellaris patients released after the first of the month.
In regard to future negotiations, Kweskin said “we don”™t have anything scheduled, but it is our hope and intent to go back to the table and continue to pursue this.”
Stellaris spokesman Geoffrey Thompson said of reimbursement rates, “there was a counter offer on the table that Blue Cross never responded to.”
“Stellaris is still ready to negotiate, and so far Empire has not indicated any interest to negotiate,” he said.
Kweskin said it all comes down to cost.
“We just passed this big health care reform bill, but there is very little in it on controlling costs,” she said. “It always comes down to negotiation. The insurer is looking to ensure members have the broadest access to providers, but at the same time, you have to balance that with the cost to members. It”™s always cost and access and how you come to find the right balance.”
The total Empire BlueCross BlueShield membership figure for the Stellaris service area is 414,955 contract holders with 338,484 dependents.
WellPoint is the nation”™s largest health insurer with one of every nine Americans a member of a WellPoint affiliated health plan. The company reported a profit of $4.75 billion for 2009.
Thompson said the end of contract has been “very disruptive” to patients and it is nearly impossible to count how many have been affected.
“There”™s an 888 number where a patient can call in and they”™ve been receiving hundreds of calls, but that doesn”™t include the calls that have gone to the individual hospitals who are fielding calls themselves,” he said. “I was talking to one of the hospitals and they said, ”˜You don”™t know how many people are saying I will go elsewhere because you don”™t take BlueCross anymore”™ so it”™s really an unknown quantity.”
Empire BlueCross BlueShield underwent another heated round of negotiations last summer with Westchester County-based Pinnacle Healthcare, which operates Hudson Valley Hospital Center in Cortlandt Manor, Sound Shore Medical Center in New Rochelle and Mount Vernon Hospital.
A multiyear contract agreement was reached after a debate over rate reimbursements.
Empire BlueCross BlueShield members may inquire about benefits coverage through (800) 495-9323.
