Children’s Hospital, Anthem reach agreement after two-month standoff

Connecticut Children’s Medical Center and Anthem Blue Cross and Blue Shield announced today that they have reached a multi-year agreement, ending a two-month dispute that led to uncertainty and confusion for many patients and their families.

The hospital and the Connecticut Children’s Specialty Group had dropped the insurer April 16 after both sides failed to reach an agreement after a year of negotiations.

Under the deal, Anthem will immediately resume covering in-network costs. Anthem has also agreed to pay for claims from members who received services from the hospital or the specialty group from April 16 to June 11 at in-network rates.

“This is welcome news for the hundreds of families who rely on CCMC for their child’s care – many of whom faced a great deal of uncertainty in light of this contract dispute,” Attorney General George Jepsen said in a press release. “I’m pleased that the matter has been resolved and that patients who received services following the contract lapse will not be charged out-of-network rates for that care.”

The dispute between the state’s only freestanding children’s hospital and the state’s biggest insurer had centered on rate increases. The hospital said Anthem would not allow adequate rate increases. Hospital leaders claimed Anthem reimbursed the hospital at a rate that is 28 percent less than the national average for children’s hospitals.

Anthem had said the old contract had more than covered the hospital’s costs of providing services to Anthem members. Anthem officials said they wanted to make sure members had access to care at an affordable price.

Both sides declined to give any details about the terms of the new contract.

State Healthcare Advocate Victoria Veltri said that during the dispute she fielded about 400 calls from families confused about coverage and worried about continued health care from the hospital and specialty group.

“In the beginning there was incredible confusion. Then it turned into a lot of worry about whether many kids with complex health care needs would actually get their care in a timely way,” Veltri said.

Veltri said she hopes to propose legislation that would hold patients harmless during these kind of disputes.

“No patient should have to go through what these patients had to go through,” she said.

Connecticut Children’s President and CEO Martin J. Gavin acknowledged the effect of the standoff.

“We truly understand the impact that this situation has had on children and families and we are pleased to have reached a resolution,” Gavin said in a prepared statement. “Many families have confirmed that there is no other hospital in the state that can care for their child the way that we can and we are thrilled that Anthem’s members will once again have access to the high-quality care that their children deserve.”

In addition to the Hartford-based hospital, Connecticut Children’s also runs the neonatal intensive care unit at UConn’s John Dempsey Hospital in Farmington and the pediatric program at St. Mary’s Hospital in Waterbury.

Anthem President David R. Fusco said in a prepared statement that he was pleased with the agreement.

“We believe we have reached the right deal, including initiatives that support our collective efforts to improve quality and outcomes,” Fusco said.

“This is excellent news for the many families who rely on both Anthem and the Connecticut Children’s Medical Center to care for their children,” said Gov. Dannel P. Malloy.