East End hospitals at odds with insurer

Unresolved negotiations over health insurance reimbursements could again leave 2,500 patients in eastern Suffolk wading through the regulations covering out-of-network benefits or selecting another hospital or doctor.

The East End Health Alliance, which negotiates reimbursement rates for the area's three hospitals, and insurer UnitedHealthcare/Oxford have been unable to reach a contract agreement. The alliance negotiates rates for Peconic Bay Medical Center in Riverhead, Southampton Hospital in Southampton and Eastern Long Island Hospital in Greenport.

Insurance reimbursements are typically set for two or three years, and hospitals on the East End -- whether acting individually or negotiating collectively -- seek rates that insurers complain are too high. It has led in the past to those hospitals losing network payments until negotiations are completed. A similar dispute upended patients in 2009, when the alliance and insurer Empire BlueCross BlueShield were at odds over reimbursements.

Fully funded UnitedHealthcare/Oxford plans are still completely covered. The problem -- which developed when no new contract agreement between the hospitals and the insurance company was reached on Friday -- is limited to self-insured groups, such as some municipal contracts and the East End Health Plan/UnitedHealthcare.

The situation could get a lot worse on Sept. 15, the end of a cooling-off period in some other contracts. Then, the number of East End patients facing higher out-of-network costs for both hospital costs and visits to their doctors offices will jump to 30,000, said officials at UnitedHealthcare/Oxford.

Paul J. Connor III, chief executive of Eastern Long Island Hospital, said some individual doctors were seeking in-network status from the insurer, and suggested that patients with questions about their coverage status talk to their doctors or their insurance company.

Those declared out-of-network are covered in some cases, such as treatment in an emergency room that leads to hospitalization, or maternity care in the last weeks of pregnancy.

Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare/Oxford, said individual policy holders were being contacted about the change in status, and warned that changes in reimbursement rates could lead to increases in health insurance premiums.