Update on Ellis Medicine Contract Negotiations

Empire is committed to making sure our members have access to high quality, affordable healthcare. One way we do this is by negotiating the rates we pay doctors and hospitals for the care they provide our members.  

Hospitals and facilities at Ellis Medicine are in our plans’ networks, but that may change. We have been working with Ellis Medicine in good faith to keep them in our networks and have made a fair offer that takes current and historical inflation into account. Based on this, we do hope that our shared priorities, the people and communities we jointly serve, will guide Ellis to reach an agreement with us. If this does not happen, Ellis Medicine hospitals and physician groups will not be in Empire plans’ networks starting March 1, 2023.  However, based on New York law, Empire and Ellis Medicine will continue to abide by the terms of the agreement during a “cooling off” period which means Empire will continue to pay claims at in-network benefit levels for two months ending on May 1, 2023.

Ellis Medicine facilities include:

• Ellis Hospital
• Ellis Hospital Skilled Nursing Facility Unit
• Bellevue Woman’s Center
• Medical Center of Clifton Park
• McClellan Street Health Center
• Ellis Physicians Group

While there are no changes to your health plan right now, if we don’t reach an agreement with Ellis Medicine, then except for certain transitional care outlined below, you will pay more for the care you receive from these hospitals, facilities or physician groups on or after May 1, 2023. This is because hospitals, doctors, and other healthcare professionals not in our plans’ networks can charge you more. They can also bill you if there is a difference between what we pay them for your care and the amount they charge (unless emergency care or admission through ER).

This affects networks for our HMO, PPO, individual, small group, large group, 32BJ, State of New York, and City of New York plans. Our networks for Medicaid, Medicare Advantage, Federal Employee Program, and National Accounts plans are also affected.

If you are a Medicare Advantage HMO member, a dedicated Medicare customer service team is on call if you have questions or need help. Please call the number on your member ID card.  

For Medicaid members, a dedicated Medicaid/HealthPlus customer service team is available Monday through Friday from 8 a.m. to 8 p.m. ET and Saturday from 9 a.m. to 5 p.m. ET. Please call 800-300-8181 (TTY 711) if you have questions or need help.

Frequently asked questions (FAQ) regarding Ellis Medicine’s status

Q: How can I stay up-to-date on Ellis Medicine’s status?

A: For the most up-to-date information call the Member Services number on your Empire member ID card.

Q: What are the issues being discussed between Empire and Ellis Medicine during these negotiations? 

A: Empire cannot comment on the specific issues being discussed, but contract negotiations are a standard, normal and routine part of what we do. Our main priority during these negotiations is to ensure our members have access to healthcare that is affordable and flexible.  We continue our efforts to try and reach an agreement that would protect affordability and flexibility for our members and keep Ellis Medicine in our network beyond May 1, 2023.

Q: When does the contract with Ellis Medicine end? What does this mean to me?

A: If a new agreement with Ellis Medicine is not reached, Ellis Medicine will no longer be an in-network provider with Empire effective May 1, 2023.  Some doctors affiliated with Ellis Medicine will also be out of network as of May 1, 2023.  In addition, doctors who only admit to Ellis Medicine and do not have admitting privileges at another in-network hospital may also be impacted.  Except for certain transitional care services discussed below, this means any claims for services provided by Ellis Medicine on or after May 1, 2023, will be considered out-of-network.

Q: What Ellis Medicine facilities and practices would be affected if a new agreement is not reached? 

A: Ellis Medicine affected facilities include:

• Ellis Hospital
• Ellis Hospital Skilled Nursing Facility Unit
• Bellevue Woman's Center
• Medical Center of Clifton Park
• McClellan Street Health Center
• Ellis Physicians Group

Q: What do I need to do if a new agreement is not reached? 

A: You don’t need to do anything unless you:

• Are being treated at an Ellis Medicine facility or by an Ellis Medicine doctor on or after May 1, 2023. 
• Are scheduled for treatment at an Ellis Medicine facility or by an Ellis Medicine doctor on or after May 1, 2023.
• Have questions about your coverage or need help accessing services in Empire’s networks.

If any of these situations apply to you, please call the Member Services number on your Empire member ID card.

Q: I want to avoid out-of-network charges. Who else can I see for care? What are the alternative in-network care providers available to me?

A: We want to assure you that even if a new agreement with Ellis Medicine is not reached you will continue to have access to nearby in-network hospitals. Please visit http://www.empireblue.com for a complete listing of in-network hospitals and other in-network providers.

Q: Would Ellis Medicine doctors be affected if a new agreement is not reached? 

A: Some doctors who only admit to Ellis Medicine and do not have admitting privileges at another in-network hospital may also be impacted if a new agreement with Ellis Medicine is not reached. You may face higher out-of-pocket costs when receiving services from an out-of-network doctor or at an out-of-network hospital. To check if a doctor or hospital is part of your plan’s network, log in to empireblue.com, or call the Member Services number on your Empire ID card.

Q: What products/plans would be affected by if a new agreement is not reached?  

A: All of the Empire networks in which Ellis Medicine participates would be affected, including the networks for our commercial lines of business (including HMO, PPO, individual, small group, large group, 32BJ, State of New York, City of New York), Medicaid, Medicare Advantage, Federal Employee Program, and National Accounts.

• As of May 1, 2023, if you choose to see an out-of-network provider, you risk having to pay much higher costs because your benefit contract likely provides lower benefits for out-of-network services and because an out-of-network provider can bill you for any difference between what we pay them for your claim and the amount they charged you.  
• Medicaid: A dedicated Medicaid/HealthPlus customer service team is available from Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5 p.m. Please call 800-300-8181 (TTY 711). 

Q: Will I be covered for emergency care services at Ellis Medicine if it becomes an out-of-network provider? 

A: In an emergency, you should always go to the nearest emergency room. Emergency Services, including those received from Ellis Medicine, will continue to be covered according to your benefit contract and governing state and federal laws. You may be responsible for charges over your plan allowance based on the terms of your benefits.

Q: What happens if I am an inpatient at Ellis Medicine and it becomes an out-of-network provider? 

A: If you’re an inpatient on March 1, 2023, then you may continue to receive services at Ellis Medicine under the terms of your benefit plan for up to 90 days.

Q: What if I am pregnant, can I receive maternity care services at Ellis Medicine if it becomes an out-of-network provider? 

A: If you are pregnant as of March 1, 2023, you will be able to continue receiving care under the terms of your benefit plan through the delivery of your child and post-partum care directly related to the delivery.  Medicaid Products:  If you are more than three months  pregnant as of March 1, 2023, then your care will be covered including postpartum care.

Q: What if I am not pregnant and I am receiving services at Ellis Medicine as of March 1, 2023.  Will my care be interrupted if Ellis Medicine becomes as out-of-network provider?

A: If you are in an ongoing course of treatment at Ellis Medicine, you may continue to receive covered services under the terms of your benefit plan at Ellis Medicine for up to 90 days. You should contact Empire at the number below if you think you are entitled to continued care at Ellis Medicine.

Q: What if I am scheduled for an elective procedure at Ellis Medicine on or after May 1, 2023 and Ellis Medicine becomes an out-of-network provider?

A: Except as described above, you will need to change any inpatient or outpatient elective surgeries, or elective procedures scheduled at an Ellis Medicine on or after May 1, 2023.  Unless we authorize it in advance, your provider will need to relocate those surgeries or procedures to another hospital or facility that participates in an Empire provider network and that supports your benefit plan.  If that is not possible, your provider will need to refer you to another provider who can render the care you need at a hospital or facility  that participates with Empire.

Q: Will I have to change my Primary Care Physician (PCP) if Ellis Medicine becomes an out-of-network provider? 

A: If your PCP is an Ellis Medicine physician you may need to change your PCP. You may receive a letter indicating your PCP has left the network. In that case you will need to select a new PCP, or a PCP will be assigned for you. We can assist you in changing your PCP.

Q: I’m a transplant patient at Ellis Medicine. Will I be impacted if Ellis Medicine becomes an out-of-network provider?

A: Empire Medical Management will be contacting and working with each transplant patient during this time.

Q: When I (or my provider) called, we were advised that the services I received were in-network, but the claim was denied or paid as out-of-network. This can't be right, what should I do?

A: Ask your healthcare provider if a Transitional Care form or pre-authorization exists for this service.

Q: How will claims for services received at Ellis Medicine be paid if Ellis Medicine becomes an out-of-network provider? 

A: Empire BlueCross BlueShield would issue payment for covered services directly to you.  You would be responsible for paying the hospital. If the hospital no longer files claims to Empire BlueCross BlueShield directly, you must submit the claim and a copy of the bill to Empire BlueCross BlueShield, P.O. Box 1407, Church Street Station, New York, New York, 10008-1407.