MedicAlert: Sound Shore Hospital Drops Out of Empire BlueCross BlueShield Plan

Written By: Robert Cox

2D12C062-1D5E-4DE4-A4FC-5C67DA625F6C.jpgIn a move with wide implications for public employees and retirees in New Rochelle ranging from school teachers to first responders to sanitation workers, Empire BlueCross BlueShield is informing members that Sound Shore Medical Center of Westchester in New Rochelle will drop out of the Empire Plan provider network effective June 30, 2009. Sound Shore Medical Center is part of the Pinnacle Group of hospitals which also included Mount Vernon Hospital and Hudson Valley Hospital Center in Cortlandt Manor. All three hospitals are dropping out of the Empire Plan network.

Empire BlueCross BlueShield continues to negotiate with Pinnacle and remains hopeful and agreement can be reached before the June 30 deadline. Meanwhile, Empire Plan members are being directed to other area hospitals include Lawrence Hospital in Bronxville, Montefiore Medical Center in the Bronx and St. Joseph’s Medical Center in Yonkers.

As of June 30, 2009 only the following services provided by Sound Shore Medical Center will be covered on an in-network basis.

  • Cases of emergency; the patient may be moved once stabilized
  • If no in-network hospital exists that can provide the services required
  • If a network hospital is not available within a 30 miles radius from the member’s home
  • For continuation of care for pregnancy or health risk
  • For any services that were previously authorized

Empire Members who go to Sound Shore anyway will be covered on an out-of-network basis which means the member is responsible for 10% of the billed charges up to the first $1,500, although some charges may be covered under other parts of the Empire plan. Members will not be eligible for paid-in-full services for anesthesia, radiology or pathology at Sound Shore. The Empire Plan member will also be directly responsible for all bills and so have to manage a great deal of paperwork. The changes have no impact on the medical portion of the Empire Plan insured and administered by United HealthCare.

Empire Plan members with questions can speak to an Empire BlueCross BlueShield representative by calling toll-free at (800) 495-9323.