Less than a week after PBMC Health publicly announced its plans to join North Shore-Long Island Jewish Health Center, the East End Health Alliance voted to begin the process of breaking down the three-hospital relationship formed seven years ago.
Alliance chair Patricia Stewart, a board member with Southampton Hospital, confirmed news of the agency’s decision on Thursday afternoon. (more…)
KATHARINE SCHROEDER PHOTO | Eastern Long Island Hospital
East End hospitals are now accepting six out of eight insurance plans offered to Suffolk County residents through the state’s healthcare exchange marketplace, according to hospital officials.
TIM GANNON PHOTO | The entrance of the former LIU campus in Southampton.
The former campus of Southampton College could become the new home of Southampton Hospital under an agreement being negotiated between Stony Brook University, which owns the campus, and Southampton Hospital, officials announced Monday.
Representatives with Stony Brook, which is part of the State University of New York (SUNY) system and Southampton Hospital, which is privately run, have signed a non-binding letter of intent in which Southampton Hospital “would join the Stony Brook Medicine healthcare system, as the two hospitals work more closely to improve healthcare quality,” officials said.
Stony Brook Medicine is the healthcare system that runs Stony Brook University Hospital.
Under the proposal, Southampton Hospital would provide care under Stony Brook University Hospital’s state operating license, officials said.
The contract between the three East End hospitals and Oxford/United Healthcare was renewed at midnight on Sept. 14, just as it was about to expire.
Roughly 3,000 local school employees insured through United Healthcare’s East End Health Plan had been without coverage at the hospitals since July 15. Another 12,000 Oxford/United participants were due to be out of network as of Sept. 15.
While out of network, cardholders were eligible for emergency room and maternity care services, but needed to go to in-network hospitals farther west for surgical and other services.
Eastern Long Island Hospital President and CEO Paul Conner said Thursday morning that the contract was signed “at the stroke of midnight, literally. We were a little anxious, but hopeful. At the end of the day it all came together. We’re happy to see that the East End Health Plan, which is administered by Oxford, is back in network, two months to the day after they went out.”
The three hospitals now negotiate with health insurance companies as a single entity, known as the East End Health Alliance (EEHA.) The group was formed, in part, to offer the facilities better leverage in dealing with larger insurance corporations.
Mr. Conner, the alliance’s spokesman, said details of the new contract will be made public later this afternoon. He added that there will be no major changes to the hospital coverage Oxford/United participants receive.
Although the contract between the East End’s three hospitals and Oxford/United Healthcare expired at midnight July 15, policyholders can continue to receive in-network services locally through Sept. 14.
That’s because the state requires the status quo to be maintained for a two-month “cooling off period” between the insurance company and Peconic Bay Medical Center, Eastern Long Island Hospital and Southampton Hospital, known collectively as the East End Health Alliance.
If a new contract isn’t secured by Sept. 15, the hospitals will continue to provide emergency services to those with Oxford coverage, but can provide non-emergency services only on an out-of-network basis.
Pregnant women insured by Oxford who were in their second or third trimester as of July 15 may be covered through postpartum care.
Talks that had broken off between the two sides resumed last week, but neither side is talking about the state of those negotiations.
Approximately 3,000 employees of several East End school districts are affected by the lack of a contract. If no deal is struck by Sept. 15, the impact will be felt by an additional 12,000 people covered by such plans as Oxford Liberty and Oxford Freedom.
All is quiet from negotiators representing East End Health Alliance and Oxford/UnitedHealthcare, which have been at an impasse over a new contract since midnight July 15. But the two sides did resume talks on Wednesday, according to insurance company spokesman Frank Perry.
Approximately 3,000 employees of several East End school districts are affected by the lack of a contract, which puts Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital out of network for them. And if a new contract isn’t worked out for these self-insured school plans by Sept. 15, it’s estimated that 12,000 more people currently enrolled in other plans, such as Oxford Liberty and Oxford Freedom, would also be out of network.
According to the health plan’s website, employees of the Greenport, Southold, Oysterponds and Shelter Island school districts are covered through the plan, along with several school districts on the South Fork.
The local hospitals will not be able to offer elective treatment to the plan’s subscribers while they are out of network, but emergency room services and admittance through the ER will continue to be provided, as is required by law.
At all three hospitals, surgeries authorized before July 15 and maternity treatment for pregnant women in or beyond their second trimester are still covered.
Locally, self-insured plans include, but are not limited to, East End Health Plan/United Healthcare. Subscribers should contact plan administrators to request clarification of their out-of-network benefits.
Patients in the self-insured plan eligible for out-of-network benefits can schedule elective hospital services but would be responsible for deductibles and co-insurance obligations.
“We understand how important it is for families to know that when their community hospital is needed, their care will be covered by their health care insurance plan,” a statement on the EEHA website says. “However, providing quality health care requires an adequate level of payment from health care plans.’
The termination of hospital services doesn’t affect doctors, although they could be affected if there isn’t a contract by Sept. 15, according to the EEHA website.
The roughly 3,000 participants in the East End Health Plan, many of whom are employees in local schools, no longer qualify for treatment at the three East End hospitals.
As of midnight last Friday, the three hospitals that form the East End Health Alliance — Eastern Long Island Hospital in Greenport, Peconic Bay Medical Center in Riverhead and Southampton Hospital in Southampton — are no longer in network for participants in the plan, which is partially underwritten by Oxford/United Healthcare.
ELIH President and CEO Paul Connor said Monday that he and the other hospitals are anxious to get back to the bargaining table to bring the hospitals back in network for East End Health Plan’s subscribers.
“We want to work with Oxford to minimize the out of network period. We would like to get back to the table,” he said. “We’ve been trading correspondence and we’ll be reaching out to them this week to try to re-engage.”
Representatives from East End Health Plan were not immediately available for comment.
According to the health plan’s website, employees of the Greenport, Southold, Oysterponds and Shelter Island school districts are covered through the plan, along with several school districts on the South Fork.
Though the local hospitals will not be able to offer elective treatment to the plan’s subscribers while they are out of network, Emergency Room services and admittance through the Emergency Room will continue to be provided, as is required by law.
Surgery that was authorized prior to July 15 and maternity treatment for pregnant women in or beyond their second trimester is also still covered.
Mr. Connor said that while he hopes a deal with Oxford/United Health care can be reached for the East End Health Plan participants, another 12,000 enrollees in Oxford’s fully insured plans may also face going out of network if the insurance company doesn’t reach a deal with the hospitals within 60 days of July 15.