CORTLANDT MANOR – As many as 50,000 Empire Blue Cross Blue Shield subscribers in Westchester County may need to find new doctors and hospitals next month if an agreement is not reached with Hudson Valley Hospital Center, Mount Vernon Hospital and Sound Shore Medical Center. All three hospitals operate under the umbrella of Pinnacle Healthcare, Inc.

The bad blood in the negotiation process between the for profit Empire Blue Cross Blue Shield and non-for-profit hospitals involves reimbursement rates and approval for major services by the insurer, according to John Federspiel, president of Hudson Valley Hospital Center (HVHC).

Empire Blue Cross Blue Shield is owned by the Indianapolis-based WellPoint, Inc., the nation’s largest health benefits company.

Federspiel said that WellPoint, Inc. is putting profits in front of patient care.  Hospital officials said that Empire is reimbursing them at a similar rate as Medicaid and Medicare. “We need a 25 to 35 percent increase from Empire in order to serve their subscribers,” said Federspiel.

Family members of elderly hospital patients spoke out at a news conference. Aline Morris’ said her elderly mother has been denied rehabilitation services by Empire following emergency treatment for a stroke at Hudson Valley Hospital Center. “Time is slipping. She has had a stroke and there is a window of opportunity, as I understand it from doctors that she has a chance to recover. That time is being spent upstairs. Empire needs to come through,” said Morris.

Empire Blue Cross Blue Shield issued a statement on June 12 outlining their service approval policies and process: “All medical treatments are determined by a patient’s physician—and is never prescribed or denied by Empire Blue Cross Blue Shield.”

In the same statement, Empire raised questions about the community hospitals’ efficiency and reimbursement increases in the past. At the news conference, the community hospitals flatly denied the claim that they have been operating inefficiently.

WellPoint said their operating revenue in the first quarter of 2009 as being $15.3 billion. “The benefit expense ratio was 81.6 percent in the first quarter of 2009, a decrease of 350 basis points from 85.1 percent in the prior year quarter.

The decline resulted principally from disciplined pricing and operational improvements in the Senior and Local Group businesses,” according to a company’s news release.

Bonnie Raab of Putnam Valley believes her mother’s treatment was delayed due to the insurance company’s red tape and for profit status. “At 86, Blue Cross Blue Shield shouldn’t make her an invalid, which is what they kind of decided on June 9. They decided she didn’t need rehabilitation. What was the point? She was very independent and we want her back,” said Raab.

MidHudsonNews.com has learned that Empire has since approved rehabilitation services for Mrs. Raab.

Federspiel said that Empire was a not-for-profit entity during their last negotiation three years ago. Negotiations then were arduous, but not acrimonious, said a hospital official. “WellPoint is trying to map on—or layer on—their national approaches they have used in California and other regions of the country here in New York,” said Federspiel.

If an agreement is not reached by the deadline, even doctors practicing at Hudson Valley Hospital Center will have to affiliate with other hospitals.

Empire insures employees of the Hudson Valley Hospital Center and the City of Peekskill, according to speakers at the news conference.

Neale Sanchez, a chronic diabetic, said he does not want to have to drive 30 minutes to another emergency room if the Empire Blue Cross Blue Shield contract expires on June 30.