| Home | Leadership | Services | Medical Staff | News | Careers | Events |
FREQUENTLY ASKED QUESTIONS
About Empire Blue Cross Health Benefits
How are you affected while the hospitals are out of network with Empire Blue Cross?
The impact on Empire Blue Cross members, until a contract settlement is agreed upon, depends on the individual member’s coverage as detailed below.
Members with In-Network Coverage
Members with Out-of-Network Coverage
|
||||||||||||||||||||||||||||||
MEMBERS WITH OUT OF NETWORK COVERAGE |
MEMBER |
BLUE CROSS |
| EMERGENCY SERVICES AT ALL TIMES | USUAL COPAY/DEDUCTABLE | REMAINING HOSPITAL FEES PAID DIRECTLY TO (YOU) THE MEMBER FOR REMITTANCE TO HOSPITAL BY (YOU) MEMBER* |
| ELECTIVE SERVICES AT ALL TIMES | USUAL COPAY/DEDUCTABLE | REMAINING HOSPITAL FEES PAID DIRECTLY TO (YOU) THE MEMBER FOR REMITTANCE TO HOSPITAL BY (YOU) MEMBER* |
*Patients are requested to remit payment to the business office of the appropriate hospital upon receipt from Blue Cross: Eastern Long Island Hospital (ELIH), 201 Manor Place, Greenport, New York 11944 Southampton Hospital (SH), 240 Meeting House Lane, Southampton, New York 11968 Peconic Bay Medical Center (PBMC), 1300 Roanoke Avenue, Riverhead, New York 11901 |
||
1. Is Emergency Care covered?
You are always covered for treatment rendered in an emergency. If you have an emergency and require treatment or need to be admitted due to an emergency, Empire Blue Cross is required by law to cover these services. You will only be responsible, as usual, for any co-payment or deductible for which you are currently responsible. Empire will pay you directly for the remainder of the hospital fees. We ask you to promptly submit this payment to the appropriate hospital:
Eastern Long Island Hospital Business Office, 201 Manor Place, Greenport, NY 11944
Peconic Bay Medical Center Business Office, 1300 Roanoke Ave, Riverhead NY 11901
Southampton Hospital Business Office, 240 Meeting House Lane, Southampton 11968
Your cooperation is appreciated.
2. While the Alliance Hospitals are out of the Empire Blue Cross network, they have adopted a policy to provide financial assistance to patients who may incur greater financial costs due to Empire’s out-of-network policies.
Under the Alliance policy, your community hospitals will not pursue collection of a patient’s out-of-network coinsurance obligation to the extent that it exceeds the patient’s in-network obligation under an Empire plan. The patient will remain responsible for his/her deductible. This policy applies to Empire members with commercial plans and to self-insured plans administered by Empire (which may include state, county and municipal employees, school districts and employers). This policy does not apply to Empire Senior Plan members or Child Health Plus or Family Health Plus members.
3. Under some Empire plans, patients will continue to receive in-network benefits if the patient lives more than 30 miles from a participating Empire hospital.
Other Empire plans do not provide this benefit and the patient will have to use his/her out-of-network benefits.
4. What about Elective Admissions?
For members covered by a plan that provides "out-of-network" coverage, you are only responsible for any co-payment and deductible that you are currently responsible for. As is the case with emergency services, Empire Blue Cross is responsible for the remainder of the hospital fees and will pay you directly. Again, we ask you to promptly submit this payment to the appropriate hospital:
Eastern Long Island Hospital Business Office, 201 Manor Place, Greenport, NY 11944
Peconic Bay Medical Center Business Office, 1300 Roanoke Ave, Riverhead NY 11901
Southampton Hospital Business Office, 240 Meeting House Lane, Southampton 11968
Your cooperation is appreciated.
5. What if your insurance plan does not provide Out-of-Network benefits?
For members covered by a plan that provides only for in-network coverage, EMPIRE BLUE CROSS is not responsible for the cost of elective services unless you have already received authorization from the company for any service (test, procedure, admission) scheduled after August 1. In that event, Blue Cross will cover the cost with the conditions outlined above.
6. If you do not have an authorization from EMPIRE BLUE CROSS for a planned service, we recommend that you contact your hospital directly—Eastern Long Island Hospital (631-477-5100); Peconic Bay Medical Center (631-477-574-8400); or Southampton Hospital (631-726-8555).
7. How will your maternity coverage be affected?
If you have entered the second trimester of pregnancy as of August 1, 2009, your health care coverage will not be impacted through your delivery and postpartum care.
8. How will treatment of chronic conditions or ongoing treatment (for example, chemotherapy) be impacted?
We recommend that you contact your hospital directly—Eastern Long Island Hospital (631-477-5100); Peconic Bay Medical Center (631-477-574-8400); or Southampton Hospital (631-726-8555).
9. If I am covered by Medicare and carry Blue Cross / Blue Shield Supplemental Insurance (Medi-Gap), will my coverage be affected?
No, if Medicare is your primary insurance and Blue Cross / Blue Shield is a supplemental policy, your care is not considered out-of-network.
10. If my healthcare coverage is through one of the EmpireBlue Medicare Advantage products, how will my coverage be affected?
Members are not affected since an agreement between the East End Health Alliance hospitals and Empire on these products has been reached.
11. Why did the contract expire without a new contract to replace it?
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. We owe it to the communities that rely on us to be the best that we can. Ultimately, it is the patients' interests we are trying to protect.
12. Are your physicians impacted?
The contract termination is between East End Health Alliance hospitals and EMPIRE BLUE CROSS. Physicians remain in-network and you do not have to find a new physician.
13. When will this be settled?
Please be assured that we are doing everything we can to resolve the matter between EMPIRE BLUE CROSS and the East End Health Alliance member hospitals, but it’s not possible to predict if or when the contract will be settled. Be assured that we are doing our best to bring this negotiation to a successful conclusion. We prefer to be a participating provider with EMPIRE BLUE CROSS.
14. Who can you call if you have questions?
If you have questions regarding your coverage call your benefit department at your place of employment, or call your hospital directly—Eastern Long Island Hospital (631-477-5100); Peconic Bay Medical Center (631-477-574-8400); or Southampton Hospital (631-726-8555).
If you wish to find out the status of contract negotiations, you may call 631-726-FACT (3-2-2-8).
Updated: October 1, 2009
Blue Cross Members
Get Email Updates
 |
 |
 |
|
||
 |
|
 |
|
||
Alliance Members
