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Stony Brook Hospital rejects health exchange plans

Stony Brook University Hospital on Tuesday, Feb. 4,

Stony Brook University Hospital on Tuesday, Feb. 4, 2014. Credit: Newsday / Chuck Fadely

Stony Brook University Hospital, Suffolk's only academic medical center, is not taking any of the eight plans offered in the county on New York's health insurance exchange, citing reimbursement rates that are too low to be acceptable.

No hospital on Long Island appears to take all of the exchange plans, but Stony Brook seems to be the only one not accepting any. At least one other academic medical center and safety net hospital in the region, Westchester Medical Center, also is not taking any exchange plans, citing the same reason.

"We are still in negotiation with some of the plans and have not reached agreement with them," said Dr. Reuven Pasternak, Stony Brook's CEO.

"We certainly support universal coverage and are hoping the exchange would be vehicle for that," Pasternak said. But, he said, the rates being offered are too low -- "below Medicare and approaching Medicaid," the latter generally considered a very low rate of reimbursement.

The hospital is in talks with six plans in the health exchange, Stony Brook said.

Stony Brook accepts other commercial plans -- which comprise about 50 percent of its business -- as well as Medicare and Medicaid, Gary Bie, the hospital's chief financial officer, said.

And for those people who bought plans on the exchange who need Stony Brook's level of care, the hospital has been negotiating on a case-by-case basis directly with their insurer, he said.

Among patients who have appealed to Stony Brook are Raymond Wozny, 37, and his wife Kerry, 45, of Wading River. Kerry, due in April with their first child, had been under Stony Brook's care for her high-risk pregnancy. When they found out Jan. 1 that Stony Brook didn't take their Empire plan, the couple scrambled to find other doctors and a hospital that would take them. But, Wozny said, no one wanted to take on a high-risk pregnancy at six months.

Wozny contacted Stony Brook, which negotiated a continuation of services with Empire until the baby is born, he said. "This was the scariest time ever," he said. "We were scared and upset and understandably angry at the situation. But we said we have to take deep breath and say 'the hospital is here to help.' We have a big, big sense of relief."

Westchester Medical Center said it too is "actively negotiating" with several insurance companies. "So far, none have been willing to offer us appropriate reimbursement for the cost of providing care," the hospital said in a statement.

Most Island hospitals, however, are taking some exchange plans. Eight plans on the exchange have been approved for Suffolk, nine for Nassau. Nassau University Medical Center, Nassau's safety net hospital, takes eight of nine plans. North Shore-LIJ Health System, the largest health system in the region with nine hospitals on Long Island, accepts six plans, including its own. Winthrop-University Hospital takes five on the individual exchange, as does Catholic Health Services' six hospitals.

Last week, patients in Stony Brook's cancer center saw a sign outside the registration office advising them that "Stony Brook Medicine and The Stony Brook Cancer Center are not participating providers for the new Obama care health insurance plans. In addition, the new plans do not have any out of network coverage."

Pasternak said the sign was not officially sanctioned but an "ad hoc sign by an individual with good intent" that has since been taken down.

Nevertheless, it reflects a reality that can be a shock to patients.

Ann Marie DiStefano, 57, of Middle Island, was told that she has a possible tonsil cancer that needs to be removed immediately. She said she was dismayed when she learned that the Empire Blue Cross Blue Shield plan she bought on the exchange was not taken at three hospitals near her, including Stony Brook.

She said that Stony Brook offered financial assistance, but she opted to cancel her Empire plan, pay $225 more a month and switch to a plan off the exchange that Stony Brook takes.

She said Stony Brook was "more helpful" than the other hospitals, which didn't offer her an alternative. "At least they didn't turn their backs on me," she said. Nevertheless, finding out that her health plan was essentially useless in a life-threatening situation has left her shaken.

"This was the most awful experience ever," she said.

The State Department of Health said it is not involved in contract negotiations between providers and health plans.

Stony Brook said patients in need of assistance should call the Healthcare Teleservices Office at 631-444-4392.