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Most LI hospitals to accept 5 of 9 health exchange plans; Stony Brook stays with just 1

Stony Brook University Hospital on March 26, 2014.

Stony Brook University Hospital on March 26, 2014. Photo Credit: Newsday / John Paraskevas

For the second year, Stony Brook University Hospital is taking only one health insurance plan on New York's health insurance exchange.

All other hospitals on Long Island are taking five or more of the nine plans offered.

Last year when NY State of Health debuted, the state-funded academic medical center did not take any of the state exchange plans until mid-February when it reached a deal with Health Republic -- the plan it is taking again this year.

Stony Brook said its experience with Health Republic "has been a very positive one and that affiliation is being used as a model as the hospital negotiates with several other health plans."

Gary Bie, Stony Brook's chief financial officer, said the hospital is in talks with two other insurers, which he declined to name. But, he said, the hospital had received no objections up to now about its taking only one exchange plan and has been providing services regardless of the person's insurance.

"Our approach is patient-friendly," he said. "We haven't had any complaints and the census [at the hospital] is 100 percent, so they are coming here and we're providing services regardless. I don't see this as an issue for Stony Brook."

He said that it is a "guiding foundational principle" to have insurers "pay us a fair market rate. It's a business decision."

The state Department of Health said that "there is no requirement" for a hospital to contract with a health plan. But if a patient needs a service only available from an out-of-network provider, the health plan is required to allow the patient to see the out-of-network provider at in-network cost.

Bie said that the hospital has negotiated directly with nonparticipating insurers to ensure that patients are not footing the bill for medical services.

"We're not making the patients get in the middle," he said.

But that was not reassuring to Christine Larkin of Selden -- which is why she switched this year from Empire to Health Republic as soon as she learned that the pediatrician for her 1-year-old son was accepting it.

"It's the leading hospital," she said. "I can't worry about paying tens of thousands of dollars out of network. That's a big deal."

Most other Long Island hospitals are accepting the same plans as last year. Catholic Health Services' six hospitals are taking five plans. Brookhaven Memorial Hospital Medical Center in Patchogue, J.T. Mather Memorial Hospital in Port Jefferson, South Nassau Communities Hospital in Oceanside and Winthrop-University Hospital in Mineola also take five plans.

North Shore-LIJ Health System, which offers its own health insurance plan, accepts all of the plans except Health Republic and Fidelis for its seven Island hospitals.

"Our point of view is that we're here to serve the public . . . and insurance is the vehicle," said Howard Gold, North Shore-LIJ's executive vice president and chief managed care business development officer. The health system is in talks with Fidelis, Gold said.

Nassau University Medical Center, Nassau's safety net hospital, takes eight state plans. "It is part of our mission and we want to ensure improved access to our health services for those who have now been able to become insured through the exchange," NUMC spokeswoman Shelley Lotenberg said.

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