Small Business Benefit Solutions Blog

Archive for the ‘Empire Blue Cross Blue Shield’ Category

Walgreens Pharmacies has elected to stop participating with Express Scripts, the pharmacy benefits manager of Wellpoint Blue Cross plans at the end of the year.

Walgreens and it’s affiliated pharmacies, including Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare, will stop processing Anthem and Empire Blue Cross member prescriptions on an in-network bases effective on January 1st, 2012. 

Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens.  On average, there is another network participating pharmacy within one-half mile of any Walgreens pharmacy.

You can find other participating pharmacies in your area at www.anthem.com or www.empireblue.com and then you can search by pharmacy name or by your geographic location.

If you are unsure whether your small business health plan or your individual medical insurance plan will be effected by this change, contact your carrier, your agent, or call Small Business Benefit Solutions, LLC and we’ll look up your pharmacy for you.

Stellaris Health Network hospital System drops Empire Blue Cross and Blue Shield 

After months of negotiations on a new deal regarding reimbursement rates, New York-based Stellaris Health Network said it will end its contract with Empire Blue Cross Blue Shield of New York.
 

Stellaris, based in Armonk, has four hospitals that ceased to accept Empire members on an in-network basis as of midnight March 31,including: 

• Lawrence Hospital Center in Bronxville, N.Y.
• Northern Westchester Hospital in Mount Kisco, N.Y.
• Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.
• White Plains Hospital Center in White Plains, N.Y.

Arthur A. Nizza, president and chief executive officer of Stellaris, said in his statement announcing the decision, “Our hospitals are committed to providing quality medical services to the communities we serve. However, that commitment cannot be met if we are forced to accept reimbursement rates that are far below the cost of providing the services.”
 

Nizza said Stellaris did not ask Empire for increases any greater than what it already receives from other insurers in the market. “Those increases are needed to maintain the hospital’s position in providing high-quality health services.” 

Nizza also noted that Empire is the lone insurer to refuse the higher reimbursement rates. 

Empire has responded to these charges and you can read their Stellaris Contract Term Letter.

Any member of an Empire Blue Cross plan currently under the care of a physician at one of these hospitals should contact Empire right away and request “Transitional Care Approval” to complete their treatment.  

Should Empire deny this request, you are encouraged to file a complaint with the NY Department of Insurance.