Home Health Health Briefs East End hospitals in-network with ‘major’ plans on health exchange for Suffolk...

East End hospitals in-network with ‘major’ plans on health exchange for Suffolk residents

The East End’s three hospitals are participating providers with five of the eight health insurance plans being offered on the individual marketplace to Suffolk County residents, East End Health Alliance spokesperson Paul Connor said this afternoon.

Connor, president and CEO of Eastern Long Island Hospital in Greenport, said the EEHA hospitals, which bargain collectively with health insurance providers, are participating with the “major” exchange providers.

“We are in-network with Empire Blue Cross, United Healthcare, Aetna, Affinity and Emblem,” Connor said.

The Alliance hospitals — ELIH, Peconic Bay Medical Center in Riverhead and Southampton Hospital in Southampton — are continuing to negotiate with the remaining providers on the health exchange marketplace in Suffolk, Connor said. The remaining three insurers on the individual marketplace are North Shore-LIJ Connect — established by the Nassau County-based health network — Oscar Insurance and Fidelis Care.

Stony Brook University Hospital is not yet participating with any of the eight authorized Suffolk County plans, hospital spokesperson Lauren Sheprow said today.

The reimbursement rates being offered by the insurance companies on the exchange are too low, Stony Brook CEO Dr. Reuben Pasternak told Newsday last week.

“At this time, Stony Brook University Hospital is in discussion with six plans in the exchange, and agreement with at least one is imminent,” Sheprow said.

South Fork Assemblyman Fred Thiele today blasted Stony Brook, “Suffolk’s only public hospital, operated by the State of New York,” for failing to sign up with exchange insurance providers.

“Stony Brook is the only hospital on Long Island that is not accepting any of the eight plans,” Thiele said in a press release. “This situation is unacceptable. 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.”

Thiele said the fact that Stony Brook is actively negotiating with six of the exchange providers and has taken steps to negotiate for patients on a case by case basis with
health insurance companies is not good enough.

“I also appreciate the fact that health insurance plans must provide reimbursement that is economically viable,” Thiele said.

“However, while hospital and insurance companies fiddle, it is patients that
are getting burned,” the assemblyman said. “When families require critical health care and are at their most vulnerable, the State of New York should not be contributing to
their stress.”

Thiele said the governor should step in “to bring the parties together to resolve this situation now.”

As the “safety-net” provider for the region, “providing more care to individuals who are uninsured or underinsured than any other hospital in Suffolk County,” Stony Brook “supports the goal of providing comprehensive, affordable care through national healthcare reform and is happy to help patients and support them through this period of transition,” Sheprow said.

“In any special situation in which Stony Brook University Hospital is the only hospital that can provide the care required, we will work with the patient’s health exchange plan and try to reach an arrangement for payment,” she said.

“Patients in need of immediate assistance should call Stony Brook University Hospital’s office of healthcare tele-services at (631) 444-4392.

Stony Brook’s status with the insurance providers on the exchange does not affect Southampton Hospital, which in September 2012 signed a letter of intent to affiliate with Stony Brook, Connor said. Southampton still negotiates its managed care agreements as a member of the East End Health Alliance, he said.

“This is all so new, it’s way too early to assess the impacts this will have on the hospitals out here,” Connor said. “It’s a real work in progress.”

Denise Civiletti
Denise is a veteran local reporter and editor, an attorney and former Riverhead Town councilwoman. Her work has been recognized with numerous awards, including a “writer of the year” award from the N.Y. Press Association in 2015. She is a founder, owner and co-publisher of this website.