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Hospital and Aetna Terminate Contract

Negotiations between Stony Brook University Hospital and Aetna have over the hospital remaining an in-network medical provider have failed for reasons unknown, resulting in the termination their contract with each other as of Feb. 15, but with the stipulation that the Student Health Insurance Plan, known as SHIP, will not be affected.

According to Lauren Sheprow, a university spokeswoman SHIP benefits were definitely part of negotiations and it was agreed to by Aetna to keep students in network but details of the negotiations are not known.

Aetna, who supplies approximately 4,500 students with health insurance through the university, will no longer include the hospital as an in-network provider.

The stipulation considers the hospital in-network for purposes of SHIP until Aug. 16, and out-of-network for all other Aetna plans.

Aetna members not enrolled in SHIP can expect higher out-of-pocket costs of 30 percent in some cases for certain hospital services such as room and board, anesthesia, x-rays, and certain psychological services.  Those with plans that do not have out-of-network benefits could pay even more.

Students are required to have coverage to register for classes; those who aren’t covered under a parent’s or employer’s plan must sign up for insurance through the university, which costs between $400 and $600 per semester.

According to Leta Edelson, the student health insurance office manager, the SHIP plan will go out for bid and a new plan will be put in place before the August expiration date.

The university insurance office is expecting competitive bids to come in by the end of this month, but they have no idea what premiums will be offered by bidders, or what the final agreement will be, Edelson said.

The new contract will include a clause that protects students if a similar issue should arise in the future.

In a letter posted on the university medical center Web site, Steven L. Strongwater, the chief executive officer of the center, urged those affected to help apply pressure to Aetna and insist the hospital remain in-network.

“After extended negotiations and despite our best efforts, as of February 4 at 5 p.m., we have been unable to conclude what we believe is an equitable agreement with the insurer and, regretfully we cannot continue to offer those services to members of Aetna under the terms Aetna is proposing,” he wrote.

Before the negotiations ended, Matt Wiggin, Aetna business communications spokesperson, said, “We hope to reach an agreement that will not unreasonably increase the cost of care for Suffolk County residences and businesses, or Stony Brook students covered under the Aetna Student Health plan.”

After negotiations concluded, Wiggin said, “The SHIP was an important factor in our negotiations and we are pleased that we were able to reach an agreement for our student health members.”

According to the hospital Web site, although the contract has expired, Aetna and the hospital are still negotiating and Aetna could on a new SHIP along with other insurers.

This is the latest occurance in the wake of a national debate on health care reform while other New York hospitals dispute with insurance companies over their contracts.

According to the Empire BlueCross Blue Shield Web site, www.empireblue.com, East End Health Alliance, which includes Southampton Hospital, terminated its contract with Empire last August.

Empire claimed that the three hospitals comprising the health alliance, which is an affiliate of Stony Brook Medical Center, sought rate increases in excess of 50 percent and those increases would cause health care costs to quickly and dramatically spike.

Empire was also in contract negotiations with Stony Brook University Hospital last July, but the two parties were able agree on the hospital’s reinbursement rates and implimented a multi-year deal.

Stony Brook is the only Level I Trauma Center and tertiary care hospital in Suffolk County, leaving many insured with Aetna weary. Those insured with Aetna who sustain serious injury, such as massive head trauma,  requiring Level I care are looking at hefty medical expenses, even with the out-of-network benefits.

It appears that Aetna has sympathized with at least one student by agreeing to the SHIP stipulation.

Enida Zekovic, 19, a health and sciences major, said, “It’s unfair and these insurance companies should give students a break.”

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