<body><div><img src="https://img.particlenews.com/image.php?type=thumbnail_580x000&amp;url=4fIPL1_0vkx8Osq00" alt="https://img.particlenews.com/image.php?url=4fIPL1_0vkx8Osq00" width="1320" height="743" >CAMILLUS, N.Y. — The dispute between Excellus Blue Cross Blue Shield Insurance and St. Joseph's Health threatens to put further strain on an already overburdened hospital system in Syracuse, according to a local paramedic.This week, patients with St. Joseph's Health began receiving letters explaining that there is a high risk that coverage under Excellus may be gone in 2025. St. Joseph's Health President and CEO Steven Hanks told patients in that letter that Excellus is frequently denying patient claims and has delayed payments, calling upon Excellus to "pay us fairly for the care we provide." The current agreement between the two will expire by Jan. 1; patients beyond the primary Syracuse hospital could lose coverage as well if they receive services at certain St. Peter's Health Partners Medical Associates practices in Fulton, Montgomery, Warren, Saratoga, Schenectady, and Ulster counties.Officials with Excellus pushed back on the claims made by Hanks, stating that the insurance company is always in compliance with New York State Law with respect to payments. Chief Medical Officer and Senior Vice President Lisa Harris said that St. Joseph's Health and its partners are being unreasonable, asking for "double-digit" rate increases."We as an insurance provider, when we have to pay more, the costs are passed on to our members,” Dr. Harris said, calling what the health provider is asking for "unconscionable."Ed Binn, Director of Operations at WAVES Ambulance in Camillus, said he's highly concerned. Patients using Excellus in the Central New York area are already out of network at WellNow Urgent Cares after the two parties failed to find common ground heading into 2024; if patients are forced to pay out of pocket for care at St. Joseph's Health, he said they will likely instead turn to Upstate or Crouse, putting further strain on emergency rooms.Binn said the issue would only be compounded if Excellus and FamilyCare Medical Group also fail to find a resolution, with that general health practitioner voicing near identical issues with Excellus as the ones St. Joseph's Health has raised. That deadline is also Jan. 1, 2025."I worry about that for the end user aspect for EMS. If the patients are hesitant to go to their own family doctor for their medical needs because of the insurance and they're hesitant to go to the urgent care because of the insurance, what do you think they're going to do next? they call 911," Binn said, "right now with the hospitals being as busy as they are, it's very difficult."According to Binn, he and his employees at WAVES are covered by Excellus. He said that the not-for-profit originally requested a high increase in premiums that were later lowered via intervention from New York State; he said from where he's standing, Excellus should have enough money to match increases that are requested from the health care system."You have an insurance industry that is making money selling insurance to the general public, insuring that these people can get the healthcare they need," Binn said, "maybe pay the providers appropriately for the care they're giving."According to Excellus' Dr. Harris, any increase in cost from the healthcare side of the equation means higher costs for patients themselves. She pointed to data from Excellus that shows that the company spends 93 cents of every dollar earned on healthcare.Public figures from Excellus show, however, that the company is also struggling when it comes to revenue, a situation that could inform their willingness to cover certain expenses. In March, Excellus CEO Jim Reed reported a net loss of $23 million in 2023, the first loss since 2008. Reed said that the loss was down to the cost of medical services surging; in that same year, the compensation packages for the top ten highest paid executives at the not-for-profit went up by about 41 percent."If we decrease the amount that's spent on the running of the business, that's going to compromise the ability of the health plan to continue to function," Dr. Harris said.St. Joe's is also facing revenue trouble; according to data monitored by Pro Publica, St. Joseph’s Health lost more than $53 million in the fiscal year ending in June of 2023. Chris Pope, a Senior Fellow with expertise on health policy at the Manhattan Institute, explained that insurance is one of the first places that hospitals turn to when they are in need of increasing revenue streams.“The hospital systems are currently facing increased pressure on their revenues and they’re trying to find additional sources of funds to make up the gap,” Pope said, “insurance rates have traditionally been the easiest way for them to do this.”Dr. Erin Duffy, a expert with the University of Southern California's Center for Health Policy and Economics, said that customers have little to no agency in these kinds of disputes between insurance and health care providers, which are common nationwide. She said if there is a deal, it could happen at the last possible minute as the two groups haggle over the money involved."There's a lot of weight on these negotiations, whatever is decided at the table now really locks in those payment rates for several years moving forward," Duffy said.</div></body>

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St. Joe's and Excellus dispute threatens to put further strain on Syracuse hospital system

CAMILLUS, N.Y. — The dispute between Excellus Blue Cross Blue Shield Insurance and St. Joseph's Health threatens to put further strain on an already overburdened hospital system in Syracuse, according to a local paramedic. This week, patients with St. Joseph's Health began receiving letters explaining that there is a...