With contracts in limbo, healthcare advocate urges action by insurers, hospital network

Warning of the “potential failure of an entire system of care east of the river,” state Healthcare Advocate Victoria Veltri has called on the parent company of two eastern Connecticut hospitals and three insurers to resolve their ongoing contract talks.

“I’m not picking sides in this debate, but I just think that it has to get done,” she said, noting that failure to reach agreements could lead to patients having to switch hospitals or pay higher costs. “It’s confusing, inconvenient, not what these people were expecting when they paid their insurance premiums.”

On Thursday, Anthem Blue Cross and Blue Shield notified members that its contract with Eastern Connecticut Health Network, which includes Manchester Memorial and Rockville General hospitals, is expiring Dec. 31. If the two sides don’t reach a new agreement, Anthem members who get care at the hospitals would have to pay higher out-of-network rates.

Already, patients covered by UnitedHealthcare and Oxford Health Plans must pay out-of-network rates to use the Manchester and Vernon hospitals. ECHN and UnitedHealthcare — which includes Oxford — severed ties in October after failing to reach a new contract.

And the hospitals’ organization of community physicians is in negotiations with ConnectiCare over its contract, which is set to run out Jan. 31.

Together, the insurers covered more than 1.84 million people as of the end of last year, according to the Connecticut Insurance Department.

Public contract disputes between insurers and hospitals have become common in recent years as insurance companies feel increased pressures to keep costs down and as hospitals, faced with an increase in patients covered by lower-paying Medicare and Medicaid, rely more heavily on payments from private insurers to help balance their books.

But Veltri said the combination of three potential contract terminations involving one hospital system, and the length of the dispute with UnitedHealthcare, prompted her to take action.

“It’s too much at once,” she said. “I’m not blaming either side. This is what happens. But sometimes when you’re looking at business deals and what’s good for the bottom line, the patients are getting caught in the middle.”

Veltri said she’s heard from patients worried about having to switch health care providers, including one man who was worried he’d have to find another hospital for his ongoing cancer treatment.

Patients receiving ongoing care, such as follow-up care for surgery that occurred before the contract expired, are allowed to continue without facing the higher out-of-network rates, but Veltri said that patients are often confused about how to make sure it happens and that the notices patients receive could be clearer.

The disputes also pose difficulties for physicians who have privileges at the hospitals, who are also unable to see patients covered by the plans without being considered out-of-network, Veltri said. Anthem and UnitedHealthcare in particular can represent a large portion of physicians’ business, Veltri said, and getting privileges at other hospitals can be a time-consuming, challenging process.

Representatives for ECHN and the insurance companies said they are still negotiating.

UnitedHealthcare spokesman Daryl Richard said the company delivered a proposal to ECHN last week and is awaiting a response.

“We’re still in active negotiations and remain at the table and hope something can get put together,” he said. “A lot of it’s focused on making sure that we can both arrive at a rate that’s fair to our customers who are paying premiums, as well as what’s fair for ECHN to remain competitive.”

In a statement, ECHN said it welcomed Veltri’s concern and that it had been working with other state officials, including legislators and Attorney General George Jepsen to get closer to an agreement with UnitedHealthcare and Oxford Health Plans.

“Our concern is that over time, inadequate reimbursements can affect our mission of patient care,” the statement said.

The statement noted that ECHN is still considered in-network for UnitedHealthcare and Oxford Medicare plans, and that it does not turn away any patients who come for care.

It also said that ECHN “continues to have productive conversations to renew contracts with several insurance carriers,” and was focused on reaching agreements as soon as possible.

Anthem spokeswoman Sarah Yeager said it’s standard procedure to notify members 30 days before a contract terminates.

A statement from the company said it is still negotiating. It also cited the insurer’s efforts to pay for better outcomes and improved quality and safety, which can help reduce costs.

“We are focused on aligning rate increases for providers with programs and measures that demonstrate safety, quality and value,” the statement said.

The ConnectiCare negotiations are with the Eastern Connecticut Physician Hospital Organization, which represents community physicians affiliated with the hospitals. Veltri said that the two sides are working under a contract extension and have built in a “pretty good safeguard.”

ConnectiCare spokesman Stephen Jewett said the company would continue to work toward an agreement.

“Negotiating with hospitals is part of our business and our value that we provide to our customers, and it’s a way for us to try to control the costs in the health care system and lower costs for our customers,” he said.

Another major insurance carrier in the state, Aetna, reached a three-year deal with ECHN in October.

ECHN has a hotline to address questions or concerns about health insurance coverage at 860-533-6566. People can also email info@echn.org.

The state Office of the Healthcare Advocate, which can help consumers with insurance questions, can be reached at 1-866-HMO-4446 or Healthcare.advocate@ct.gov.