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Stellaris and BlueCross Talks Back On
Politicians wade into the debate as residents and workers in the villages continue to be frustrated by the impasse over reimbursement rates.

By Sean Roach | Email the author | July 30, 2010
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July 28 offer letter from Arthur Nizza.Credit Tom Auchterlonie
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Months have passed since Stellaris Health Network and Empire BlueCross BlueShield split in a disagreement over reimbursement rates.

And since April 1, tens of thousands of Westchester residents have been affected by the inability of the two sides to come to agreement. Individuals have been forced to pay out-of-pocket for medical care, or have had to seek out medical services elsewhere due to the dispute.

Stellaris runs four medical centers in the region including Phelps Memorial Hospital in Sleepy Hollow. The disagreement means that those covered by Empire BlueCross BlueShield are not covered for a majority of medical services provided at Stellaris centers. However, emergency room services are still being covered by Empire.

The frustration has grown to a point where elected officials and municipal administrators have begun throwing their weight behind the issue to force a solution.

Last Friday, New York State Senator Kirsten Gillibrand entered into the debate, urging both sides to come back to the bargaining table and expressing her "concern and dismay that negotiations between Empire BlueCross BlueShield and Stellaris Health Network of Hospitals have stalled."

Greenburgh Town Supervisor Paul Feiner has also begun an e-mail campaign directed at BlueCross. He has circulated numerous emails showing the real-life impact the dispute has had on residents with medical problems.

It seems like the mounting pressure has caused both sides to blink.

On Tuesday, Stellaris presented a new proposal to Empire BlueCross BlueShield which offered single-digit reimbursement rate increases over a three-year period, which would be tied to certain quality measures. The plan also called for reducing the readmission rate of patients, also referred to as the percentage of patients to become hospitalized again due to conditions such as infections of complications.

According to a letter between Feiner and Mark Wagar, CEO of Empire Blue Cross Blue Shield, Empire replied with an altered counter-proposal in a meeting with Stellaris on Friday. There has been no word on the status of that offer or how it has been received.

Empire has portrayed the developments as productive. In Wagar's letter, he noted that Stellaris' revised proposal "signals a compromise" and that it was "a positive development for our members and their patients."

Calls to Stellaris were answered by a machine set up specifically for the issue. Phelps Memorial Hospital directed calls to the designated spokesperson for Stellaris, Thompson & Bender Press Relations.

Geoff Thompson stuck a more cautious tone on Wednesday, stating that there was ongoing communication between the two sides, but no "meaningful discussion" at this point.

"Community hospitals can't go on like this," Thompson said. "At this point it appears some elected officials are starting to get involved to push BlueCross to the table. Maybe this will result in getting this in far more active dialog."

Thompson could not comment on the discrepancy over the reimbursement rate and could not offer any solid numbers on the issue, though Gillibrand noted in her statement that Stellaris estimates it has provided nearly $22 million in uncompensated care over the past two years.

In Tarrytown and Sleepy Hollow, there are hundreds of residents who have been impacted by the impasse. A good portion of those are workers for the municipal governments. Both municipalities offer the New York State Health Insurance Plan, or NYSHIP. A portion of NYSHIP is provided by Empire BlueCross BlueShield.

"We've definitely been affected by it," Sleepy Hollow Village Administrator Anthony Giaccio said. "I know one employee in particular, and it's been a huge inconvenience. They were very upset about it, and we tried to do what we could to get permission to go to Phelps."

In Tarrytown, Village Administrator Michael Blau said that many employees who had to have screenings, such as mammograms, were suffering the most since BlueCross BlueShield members were flooding smaller medical centers trying to find appointments.

In Greenburgh, Feiner said he got involved with the issue because of the inconvenience to municipal employees, and dozens of residents who have contacted him saying their health had suffered as a result of the impasse.

"Obviously, this has created a tremendous amount of stress for constituents and employees who subscribe to Empire BlueCross BlueShield and who have major medical needs," he said. "Some people have been forced to delay surgeries and procedures. Others are concerned because the doctors they trust and have used for many years do not have privileges at other hospitals. I have received e-mails from patients with leukemia, cancers and major/minor medical problems."

Feiner said he had scheduled a meeting with Mark Wagar, President of Empire Blue Cross Blue Shield, on August 11 if the issue has not been resolved by then.

And while there has been an offer, and a counter-offer, members of Stellaris are sticking to their guns.

"The decision is really in Empire's court," Jon B. Schandler, the President and CEO White Plains Hospital Center. "We have no room left for movement, and Empire can either reject our offer and continue to disrupt their members' health care needs or accept our new offer and end this dispute."