Termination of Contract between Stony Brook University Hospital and Aetna Health, Inc.

Frequently Asked Questions

What is happening with the contract between Stony Brook University Hospital (SBUH) and Aetna Health, Inc. (Aetna)?

The current contract between SBUH and Aetna, which includes Hospital services, expired on February 15, 2010. Stony Brook University Hospital is no longer considered a “participating” (sometimes called an “in-network” provider) in the Aetna network.

What is Aetna?

Aetna is a for-profit national health insurer that covers some residents of Suffolk County and the surrounding area for hospital inpatient, hospital outpatient, other physician and medical, pharmacy, and other healthcare services.

What happens now that the contract is terminated?

Unless the Aetna member/patient has “out-of-network” benefits, Aetna may not cover non-emergency services provided at SBUH.

Will I still be able to receive services at SBUH after February 15?

You must contact your benefits office or Aetna Health, Inc. to determine what benefits are allowed under your health plan. You will be able to receive emergency services at SBUH. If your contract has an “out-of-network” benefit, you may still be able to use SBUH services. Patients who were admitted to SBUH before the contract expired will be fully covered, as will outpatients who have already begun a continuing course of treatment.

How do I know if I have out-of-network benefits?

In general, HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) and Medicare HMOs (such as the Blue Cross Senior Plan) contracts do not offer an out-of-network benefit. Most other Aetna contracts offer varying degrees of out-of-network benefits. Check with your benefits office or subscriber handbook to determine what benefits your plan provides.

Will I be responsible for any bills?

You must contact your benefits office or Aetna to determine what benefits Aetna will allow. SBUH will continue to bill Aetna on your behalf, but it is possible that you will be responsible for some part of the bill. If this happens, please contact our Patient Accounts Department at (631) 444-4151 and we will work with you on various payment options and/or financial assistance. Based on your income and family size, you may be eligible for a reduction of your bill under the Hospital’s financial assistance program. If you receive a bill from a Stony Brook University Physician, please call (631) 444-4800.

Will visits to Stony Brook doctors be affected?

Aetna contracts separately with the attending physicians at SBUH, and those doctors remain “in- network” participating providers in the Aetna plans. This will be effective until April 20, 2010. Since many physicians have privileges only at SBUH, however, after that period Aetna may also terminate their contracts. If your Aetna policy has an out-of-network benefit, you may continue to see your physician on an out-of-network basis. If your benefit for physician services is through another insurer (a major medical plan), such as Empire BlueCross BlueShield, United Healthcare, or GHI, you may continue to see your physician. If you do not have an out-of-network benefit, Aetna may expect you to find a new participating physician. Under certain circumstances, you may be able to continue to be treated by your physician for up to ninety (90) days.

Please discuss the details of your plan with your health benefits office; if you have further questions, it is best to discuss them directly with Aetna.

What should I do if I have an appointment with a Stony Brook University Physician or have been pre-authorized for a test or treatment at Stony Brook University Hospital after February 15, 2010?

This is a decision you may want to discuss with your doctor. Also, you should check to see if your policy has an out-of-network benefit.

Please feel free to call us with any other questions regarding the termination of the contract between SBUH and Aetna at (631) 444-4392.