An unhealthy negotiation: Empire BlueCross BlueShield holders might no longer be covered at South Nassau Communities Hospital


Empire BlueCross BlueShield insurance holders on the South Shore received letters this month informing them that starting July 1, visits to South Nassau Communities Hospital may not be covered under their plans. The development comes amid contract renegotiations be-tween the health insurance giant and the not-for-profit medical center.

“South Nassau may no longer participate in our network,” said the letter, dated May 15 and signed by Dominic DePiano, vice president of provider engagement and contracting in New York for Blue Cross. Contracts between the insurance provider and South Nassau are renegotiated on a three-year cycle to address the continuously rising costs of health care.

The process involves a series of proposals and counterproposals in which hospital officials ask for a fair compensation rate and, typically, Blue Cross counters, according to Joe Calderone, senior vice president of corporate communications and development for South Nassau. This time, however, the negotiations appear to have stalled.

In an open letter to patients dated May 24, Richard Murphy, president and chief executive officer of South Nassau, said that historically, Blue Cross has offered SNCH too little when compared with how much it reimburses competing hospitals in Nassau County, which he claims can receive as much as 40 percent more for treatment of the same medical conditions.

“Blue Cross has been shortchanging South Nassau for years,” Murphy said, adding that last year, Anthem Inc. a parent company of Blue Cross, reported $3.4 billion in profit — a 55 percent increase over 2016. Additionally, Murphy said that under President Trump’s tax reform package, passed last year, Anthem benefited from $1 billion in corporate tax relief. “This dispute is about fairness and about putting patients ahead of Blue Cross’s profits,” he said.

“Meanwhile, they’re squeezing us, a nonprofit,” Calderone added.

Renegotiation between the two entities must be completed by July 1, or South Nassau patients will start paying out of pocket for non-emergency and elective services. Emergency room visits would still be covered, as woud preauthorized services — such as chemotherapy — as well as patients admitted before July 1 and pregnancies in the second or third trimester. However, Blue Cross plan holders would be responsible for paying 10 percent of the charges for those services.

“Our consumers are our number one priority,” Blue Cross responded in a statement. “There is no immediate change to healthcare coverage for our consumers as we are continuing to negotiate to reach an agreement that would enable [South Nassau] to remain part of [our] care provider network and protects affordability for our consumers.”

Although the contract expired May 1, it allows for a “cooling off” period ending July 1, during which Blue Cross coverage at South Nassau will not be impacted.

BlueCross also said in its letter that it will no longer pay South Nassau directly for services rendered, and that the hospital can refuse patients who do not require emergency treatment. Additionally, patients could be forced to transfer to another hospital once they are stabilized. Since South Nassau would be considered out-of-network, plan holders would be required to pay upfront for services — including emergency room visits — and would be responsible for filing claims with Blue Cross for reimbursement.

Blue Cross recommended that plan holders seek health care at other hospitals that participate in its network, such as Long Island Jewish Valley Stream and Nassau University Medical Center in East Meadow. “Not only will you avoid potential difficulties,” the letter read, “you will have lower out-of-pocket costs.”

In his letter, Murphy contended that other area hospitals charge higher out-of-pocket deductibles because their services are pricier than South Nassau, which is a 501(c) not-for-profit. He also wrote that South Nassau would continue to bill Blue Cross for services rendered out of courtesy to its patients, regardless of coverage type.

“We need Blue Cross to come to the table, and be reasonable and fair and provide us with the parity they are providing to hospitals in the area,” Calderone said, adding that if no agreement is reached, patients in the community who rely on South Nassau would be impacted.

“I think it’s baloney,” said Oceanside resident Carolyn Vierling, 70. She has lived in the hamlet for more than 50 years, and she and her late husband underwent procedures ranging from ankle surgery to limb amputation. “We were frequent flyers [at South Nassau] until he passed away,” Vierling said. Her entire family is still covered under Blue Cross, and she said she has seen this renegotiation happen time and time again.

Others expressed serious concerns about their well-being. Stephen Antonacci, a 28-year-old Oceansider who struggles with anxiety, said he has been dropping by South Nassau since he was 13 on a monthly basis for counseling and prescription refills. Neither would be covered after July 1. “I don’t know what I’m going to do,” Antonacci said.

South Nassau urged plan holders to contact their Blue Cross representatives and let them know they need South Nassau to remain in-network and to “make their voices heard.”