Empire BlueCross BlueShield drops another provider from some plans

About 7,000 urology and radiation oncology patients learned this week that their doctors will be dropped from their Empire BlueCross BlueShield insurance networks effective June 1.

It's the second time in a week that a large LI-based provider network said it was being kicked off Empire networks without warning. 

In the latest move, Integrated Medical Professionals of Farmingdale, a urology and radiation oncology practice with 52 locations, said it had been informed by Empire that its doctors are being taken out of the network.

Integrated Medical, which has 29 Long Island locations under the Advanced Urology Centers of New York and Advanced Radiation Centers of New York names, said patients started receiving letters from Empire during the past week.

Dr. Deepak Kapoor, the group's chairman and CEO, said Integrated plans to hold on to its patients. 

"We have decades of doctor-patient relationships impacted," Kapoor said. "Our hope is we can talk to the insurer and work it out like adults. We are exploring every recourse at our disposal to ensure continuity of care for our patients."

Empire said the decision was made as "a result of our regular network review." 

The insurer said the decision impacts patients in its Medicare Advantage HMO and Dual Special Needs Plan networks. A DSNP is a plan for patients who qualify for Medicare and Medicaid. 

Integrated's status with the Medicare Advantage PPO network and any other Empire network did not change, the insurer said.

DSNP patients can change their insurer at any time during the year, said Gretchen Jacobson, the associate director of the program for Medicare policy at the Kaiser Family Foundation, a nonprofit that focuses on health care policy. 

"This is a special rule because it's a service for people who have lower incomes and often more medical needs," Jacobson said.

Medicare Advantage HMO subscribers usually have to wait until an open enrollment period to make a change unless the Centers for Medicare & Medicaid Services (CMS) decides that the change in providers is significant enough to create a special enrollment period to switch plans earlier, she said. There are no statistics on how often that occurs, she said.

Empire also told about 1,300 cancer and blood-disorder patients that their care provider, New York Cancer & Blood Specialists, will no longer be in their insurance network effective June 1.

Insurers or practices can leave a network, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

"People are locked in to a network for a year, but the provider network itself is not locked, and that can put patients in a tough position. It's a problem," Pollitz said. "Sometimes doctors leave because of pay, and sometimes insurers look to reduce claims exposure. There is no rhyme or reason to it."

A Kaiser study from 2017 showed that Medicare Advantage plan networks included 46 percent of physicians, on average, nationwide. Medicare Advantage private plans cover 19 million people, or one-third of the Medicare population.

The study, which analyzed data from 391 plans offered by 55 insurers in a geographically diverse sample of 20 counties, found wide variation in the size and scope of provider networks, both across and within counties. Access to physicians tended to vary by specialty as well.

Kaiser said 16 percent of the studied plans included fewer than five radiation oncologists.