Syracuse, New York — Negotiations between Excellus Blue Cross Blue Shield and major healthcare providers are still ongoing. Industry experts believe that a solution to the situation may require Congressional legislation to ease the financial burden on health insurance companies.
In August 2023, the federal government announced that nearly $1 billion is headed to upstate New York hospitals after adjustments to the way Medicare reimbursements are calculated. At the time, Sen. Chuck Schumer said it was a big win for hospitals that have been hit hard by the coronavirus and have been forced to lose money and staff. Hospitals saw this as a victory because they had complained about the disparity between the care they were provided and what they actually received under Medicare.
But insurance companies and nonprofits are hurting. Excellus and similar insurance companies work with the government to provide coverage through what are called Medicare Advantage plans. Experts say that when adjustments were made to Medicare's formula, insurance companies suddenly ended up with more money under Medicare Advantage plans than they originally expected.
“Health plans, especially in upstate New York, feel like they're hitting a wall, meaning they're having to push for the toughest deals with providers,” said Bill Hammond, senior fellow at the Empire Center. “There is,” he said.
Mr. Hammond is an industry expert at the think tank. He said Excels could be more willing to accept certain requests from St. Joseph Health and FamilyCare Medical Group if legislation to balance scale for Medicare Advantage plans were enacted. He said that there is a sex.
“A lot of the solutions that people are looking for here are going to come out of Washington,” Hammond said.
Over the summer, Excellus CEO Jim Reid announced that a bipartisan group of New York members of Congress, including Congressman Brandon Williams, was making an apparent effort to address the issue. praised. But Hammond said so far there are no bills on the issue, and it would be difficult to do so without attaching it to a “must-pass” bill like an omnibus spending bill.
The current contract between Trinity Health and Family Care, which operates St. Joe's, expires on Jan. 1. Excelus claims that the demands from medical providers are unreasonable. St. Joe's and Family Care independently said Excelus was failing to adequately cover patients.
“At this stage, we continue to meet regularly and have nothing new to report. We have not reached an agreement with Excellus. We will keep patients informed of progress. Family Care “Medical Group remains committed to the fact that quality care is non-negotiable,” FamilyCare CEO Dr. Mitchell Brody said in a statement Tuesday.
Meanwhile, Excellus and WellNow Urgent Care have resumed negotiations after the two sides were unable to reach an agreement by 2024, leaving people to pay out of the region's only urgent care chain's network costs. I admitted that.
