Empire Blue Cross/Blue Shield Reverses Course

Dr. Deepak Kapoor, Chairman and Chief Executive Officer of Integrated Medical Professionals.

Empire Blue Cross/Blue Shield has agreed to reverse a decision made last month to no longer cover services oncological patients receive from facilities run by Integrated Medical Professionals of Farmingdale. IMP is the parent company of Advanced Urology Centers of New York and Advanced Radiation Centers of New York. Its 52 locations serviced 1300 Long Islanders, including East Enders who already had to drive up the island to find a facility to receive treatment.

Dr. Deepak Kapoor, IMP’s chairman and CEO, negotiated a deal that, at least for time being, will allow patients to continue to receive treatments at the facilities they are already enrolled in. He said at the time of the suspension last month that his company intended on keeping its patients.

In an interview last week, Dr. Kapoor said his company didn’t agree to any conditions but rather made Empire understand his company is the most cost-effective road for the HMO to take. “We didn’t take a hit. We are the value provider of services. We have better outcomes at a lower cost,” he said.

Empire also reportedly notified New York Cancer & Blood Specialists that reimbursements would end June 1. New York Cancer & Blood Specialists handles about 350,000 patient visits annually at its 42 locations, including 15 on Long Island.

Local cancer victims requiring radiation treatments who rely on Empire Blue Cross/Blue Shield are already inconvenienced because are a shortage of facilities hereabouts. Kapoor said his company has 170,000 patients in eastern Suffolk County alone.

“What needed to happen was for us to talk to the adults in the room,” he said of the negotiations with Empire.

Kapoor used as an example a patient who may require aggressive chemotherapy at the beginning of a treatment course that might spike up costs. “But the cost goes down dramatically over time. The payers don’t look at the outcomes.”

IMP has become the largest independent comprehensive urology group practice in the United States and is regarded as a national leader in the areas of quality management, compliance, and the development of coordinated clinical pathways.

An Empire spokesperson said the original decision to end coverage had been made as “a result of our regular network review.” The insurer said the decision affected 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.

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