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Patients Fear Mt. Sinai Will Drop Low-Cost Insurance Plans

[preamble]Thank you Obama[backtopost]

For four months, Yitzchok Shuster felt secure in the knowledge that he had signed up for a health insurance plan on New York’s Affordable Care Act exchange, and that he was still able to see his longtime doctor, who was employed by the Mount Sinai Health System.

After his insurance took effect in January, he visited the doctor, Gary Lerner, at his Forest Hills, Queens, office three or four times with minor ailments. Then at his last visit, three weeks ago, Mr. Shuster was warned that the practice was planning to drop his plan, Empire BlueCross BlueShield Pathway.

“The girl at the front desk, a real sweetheart, she told me, Yitzchok, I really don’t want to burst your bubble because we told you that they would be taking your plan,” Mr. Shuster, 52, said Thursday. “But we have it from on high that in a month or two, they’re not going to be.”

A Mount Sinai cancer patient, who asked to be identified only as Beth because she was afraid her doctors would resent her if they knew she was complaining, said she visited her Manhattan doctor, Stacy Suden, on March 24 without incident. But said she was told on Tuesday that Dr. Suden was no longer taking her insurance, MetroPlus.

Beth and Mr. Shuster appear to be among a number of people whose low-cost insurance plans are being dropped by Mount Sinai doctors. Patients said the changes were especially upsetting because the open enrollment period for insurance has passed, and federal law does not allow them to switch plans as a way of keeping their doctors.

It was not clear on Thursday whether the changes were limited to a few doctors or part of a movement by a major institution to squeeze out low-paying plans under the Affordable Care Act or force higher reimbursement rates. Since its merger with the Continuum chain last year, Mount Sinai has become New York City’s biggest private hospital system, giving it considerable clout with insurance companies.

Mount Sinai ordered the doctors not to talk to the press, according to receptionists at both offices, and messages left for the doctors were not answered. Sid Dinsay, a spokesman for Mount Sinai, confirmed that Dr. Suden had dropped MetroPlus, and said Dr. Lerner was still in Empire’s network but “may elect to change.”

Mr. Dinsay did not respond to questions about whether the doctors had been told by Mount Sinai to drop the plans or whether similar decisions had been made across the system.

The state Health Department said that it could not stop doctors from dropping plans, but that New York State law requires insurance companies to allow doctors who have dropped plans to permit patients to continue receiving treatment for up to 90 days.

Despite that law, Beth said Dr. Suden, her primary care doctor at Beth Israel, part of the Sinai system, had turned her away. She called MetroPlus, whose agents, she said, first advised her to go to the emergency room and then sent her to an internist in Chinatown who did not speak English very well and told her she might have a new cancer.

“The whole point of having an internist is that she is your internist for more than one month,” Beth said. “This is a person with medical concerns who can’t afford to be without insurance. Just somebody who speaks English would be a good start. Maybe somebody who speaks English and is good.”

Mr. Shuster said he was told that the decision to drop his plan would affect about a dozen patients in the group his doctor belongs to, Mount Sinai Medical Associates.
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Mr. Shuster, a rabbi, lawyer and small claims court arbitrator, said he was so outraged he went to Mount Sinai administrators seeking an explanation. He said Dr. Arthur Klein, president of the Mount Sinai Health Network, told him that dropping his plan was part of an effort to force the insurance companies to negotiate higher reimbursement rates.

“ ‘Rabbi Shuster, you have to understand we have a right to ensure that our employees at Mount Sinai get a decent wage,’ ” Mr. Shuster recalled Dr. Klein saying to him. “Then he told me, ‘We weren’t in favor of Obamacare to begin with.’ ”

Dr. Klein did not return a call for comment.

Mr. Shuster said Dr. Lerner told him that he would continue treating him at no charge, but Mr. Shuster said he does not like the idea of accepting charity when he has insurance. “He’s been a real mensch,” Mr. Shuster said. “But I don’t see it from the hospital’s point of view. It’s a multibillion-dollar business. I think Mount Sinai has a moral obligation not to drop any plans until the next enrollment period.”

Officials at MetroPlus and Empire said they had not yet received word of cancellations, but that doctors are required to give 60 to 90 days’ notice before dropping a plan.