Stony Brook University Hospital Empire BlueCross Negotiations
Frequently Asked Questions
1. Question: What is happening with Empire BlueCross?
Answer: The current contract between Empire BlueCross and Stony Brook University Hospital, which includes Hospital coverage for the Empire Plan, expires on July 31, 2009. Should an agreement not be reached by July 31, the contract will expire and Stony Brook University Hospital will no longer be considered a participating provider under either the BlueCross or Empire Plan network.
2. Question: What is Empire BlueCross?
Answer: Empire BlueCross is a health insurer owned by WellPoint, Inc., a for-profit insurance company based in Indianapolis, Indiana that generated $2.5 billion in net income last year. Prior to 2002, Empire BlueCross was a subsidiary of a New York-based not-for-profit organization.
3. Question: What is the Empire Plan?
Answer: The Empire Plan is a health benefit plan for current and former New York State and municipal government employees, which offers hospitalization benefits through BlueCross. This is why the expiration of the contract between Stony Brook University Hospital and BlueCross means that the Hospital no longer is in either the BlueCross or Empire Plan networks
4. Question: What is holding up the agreement?
Answer: Hospital contracts with health insurance companies must cover the actual costs of the services we provide and support our ability to reinvest to expand and improve services. Empire BlueCross’ latest offer does not fully cover the costs of providing care to our patients. If we were to agree to their offer, Stony Brook University Hospital would be forced to provide care to Empire BlueCross members valued at millions of dollars for which it will not be reimbursed.
5. Question: What happens if the Hospital does not reach an agreement with BlueCross?
Answer: If we are not able to reach an agreement, the contract with Empire BlueCross will terminate on July 31, 2009. If the contract expires, Empire BlueCross will no longer consider the Hospital as one of its participating providers under either BlueCross or the Empire Plan. Unless the member has out-of-network benefits, Empire BlueCross may not cover non-emergency services provided at Stony Brook University Hospital.
6. Question: Will I still be able to receive services at Stony Brook after July 31?
Answer: You must contact your benefits office or BlueCross to determine what benefits are allowed under your health plan. You will be able to receive emergency services at Stony Brook. If your contract has an out-of-network benefit, you may still be able to use Stony Brook University Hospital services. Patients who were admitted to Stony Brook University Hospital before the contract expires will be fully covered, as will outpatients who have already begun a continuing course of treatment.
7. Question: How do I know if I have out of network benefits?
Answer: 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 BlueCross contracts offer varying degrees of out of net-work benefits. You should check with your benefits office or subscriber handbook to determine what benefits your plan provides.
Full details for active Empire Plan members are accessible on the NYSHIP Web site at www.cs.state.ny.us/ebd/welcome/actlogin.cfm or by calling 1-877-7-NYSHIP (1-877-769-7447).
For active Research Foundation employees, details may be accessed at http://naples.cc.sunysb.edu/Admin/HRSForms.nsf/pub/HRSD0038/$FILE/HRSD0038.pdf or by calling 1-800-409-0272.
8. Question: Will I be responsible for any bills?
Answer: You must contact your benefits office or Blue Cross to determine what benefits Empire Blue-Cross will allow. Stony Brook University Hospital will continue to bill Empire BlueCross 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. If you receive a bill from a Stony Brook University Physician, please call (631) 444-4800.
9. Question: Will visits to Stony Brook doctors be affected?
Answer: Since many Stony Brook doctors have privileges only at Stony Brook University Hospital, Empire BlueCross may also terminate their contracts. If your BlueCross 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 United or GHI, you may continue to see to see your physician. If you do not have an out-of-network benefit, Blue Cross 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 Empire BlueCross. Please feel free to call us again for the latest status regarding the negotiations.
10. Question: 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 July 31?
Answer: If possible, you may want to reschedule your appointment for a date prior to July 31. 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 again for the latest status regarding the negotiations at (631) 444-4392.
