Oxford/United Healthcare impasse continues

07/28/2011 6:00 AM |

NEWS-REVIEW FILE PHOTO | Peconic Bay Medical Center in Riverhead.

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.

jlane@timesreview.com

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