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Feb 24, 2014 3:06 PMPublication: The Southampton Press

On Health Insurance Exchange, Southampton And Stony Brook Hospitals Have Different Policies, Despite Merger Talks

Feb 25, 2014 4:37 PM

Long Island residents and lawmakers were up in arms earlier this month after learning that Stony Brook University Medical Center accepts none of the eight health insurance plans offered via the state-run Affordable Care Act website.

Locally, it could prove to be a key element of a potential merger between Southampton Hospital, which does accept several of the plans, and Stony Brook.

Eight of the plans marketed on the New York State Department of Health insurance exchange are available to Suffolk County residents. Currently, however, Stony Brook University Medical Center accepts only private insurance, citing low reimbursement rates from the state-offered plans.

Stony Brook’s CEO, Dr. Reuven Pasternak, explained that the hospital is in negotiation with six of the eight insurance providers, and that reimbursement rates now being offered are in line with Medicaid rates, which he viewed as too low. Dr. Pasternak also said that the hospital is negotiating on a one-on-one basis with patients who bought a plan on the exchange.

State Assemblyman Fred W. Thiele Jr. said in a press release that his office has been contacted by many constituents concerned with the lack of plans being accepted by the county’s only public hospital. “This situation is unacceptable,” he said. “It is incomprehensible to the public that a state-operated hospital is not accepting any plans that are being offered as part of a state-operated health insurance exchange.”

The assemblyman went on to say that he saw the merit in the argument that Stony Brook needs to be reasonably compensated by the insurers, but said it is patients who will suffer. “When families require critical health care and are at their most vulnerable, the state should not be contributing to their stress,” he said, asking Governor Andrew Cuomo to step in if the negotiation standoff lasts much longer.

For its part, the State Department of Health has said that it has no say in rate negotiations between insurers and health care providers.

During an interview earlier this month, Southampton Hospital officials spoke briefly about what plans Southampton accepts and how a merger with Stony Brook could affect that.

Unlike Stony Brook, Southampton Hospital accepts Affinity, Emblem, Empire, Fidelis, Health Republic, Oscar and United Healthcare plans.

Hospital President and CEO Robert Chaloner reiterated what Dr. Pasternak said about being in negotiations with the companies. In the event of a merger, Mr. Chaloner said, the two hospitals would have to reconcile their reimbursement rates from each insurer.

The two hospitals would ultimately be sharing an Article 28 certificate, otherwise known as an operating certificate, after a merger. Essentially, in the eyes of health insurers, the two hospitals and their satellite offices would be one entity, receiving one flat rate.

In fact—although Mr. Chaloner stressed that this would be a fortunate byproduct of a merger and in no way a driver for it—the two hospitals are likely to see a large bump in their reimbursement rates from insurers, as their newly formed partnership will carry more weight in negotiating reimbursements from the insurance industry.

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This is the insurance industry paying out low reimbursements so they can keep their profits in the billions!!! And it's been going on for years....not just since the ACA.
By sandydog21 (195), Southampton on Mar 14, 14 11:31 AM
you can buy the insurance does not mean every one has to take it...
By squeaky (291), hampton bays on Mar 14, 14 12:34 PM
A surprising number also do not take Medicare.
By oystercatcher (126), southampton on Mar 16, 14 6:34 PM
Haha, where is Mets Fan when you need him? I have tried changing the insurance I offer to my employees to a more affordable health insurance exchange. I gave them three choices and asked my employees to check with their primary doctors to make sure they accepted one of the choices. Not a single doctor of any of my employees accepted any of the three choices. Good stuff huh?
By dnice (2346), Hampton Bays on Mar 14, 14 2:54 PM
Doesn't sound like the hospitals 'seeing a large bump' in reimbursement rates will help patients. Just another corporation making profits in a business that can't fail.
By M. O'Connor (147), Southampton on Mar 14, 14 3:03 PM
If it meant changing my doctor and saving $900 a month, guess what I did. I think the $1100 a month I pay now is still too much.
By Mets fan (1501), Southampton on Mar 14, 14 5:00 PM
As long as it worked out for you Mf.
By dnice (2346), Hampton Bays on Mar 14, 14 10:04 PM
By blackduck1 (20), southampton on Mar 14, 14 11:54 PM
Malpractice insurance for an Ob/Gyn on Long Island is $350,000 per year, many surgical specialties have similar rates.. New York State hospitals will go bankrupt quickly if they don' t get compensated for their uncapped legal liabilities.
By davidf (325), hampton bays on Mar 15, 14 8:20 AM
to davidf:

Do you have a citation to support that $350,000 figure? According to BC/BS, it's $186,566 on Long Island (the highest in the state.) That's a long way from $350K. In other areas of NYS, it's as little as $37,251.

Perhaps your figure refers to OB/GYNS who have been sued. The disparity between Long Island and the rest of the state is explained by malpractice attorneys plowing the field where the crops are lushest and the harvest most abundant.
By highhatsize (4217), East Quogue on Mar 16, 14 7:04 PM
That average number is for Nassau and Suffolk and is for a $1mln/$3 mln policy, which gets blown up on 1 claim. 50% of OBs in New York have over 4 claims during their career, and further:
"Ob-Gyns in New York also plan to retire at much higher
rates in younger age groups (See Figure 3). Even though a large portion of practicing Ob-Gyns in New York State are in their forties,the average age at which physician’s stop practicing obstetrics is 47 years old."
Again, that's for the ...more
By davidf (325), hampton bays on Mar 17, 14 1:50 PM
As someone with a "pre-existing condition", I like the part of the ACA which says I can't be screwed over because of it.

But the regulations still need a lot of work...
By Mr. Z (11847), North Sea on Mar 15, 14 8:05 PM
1 member liked this comment
Stony Brook recently took someone I know NY State affordable care Empire BC/BS insurance, so this article doesn't make sense.
By oystercatcher (126), southampton on Mar 16, 14 6:33 PM
What makes sense anymore?
By Preliator Lives (437), Obamavillie on Mar 17, 14 6:44 AM
1 member liked this comment