With Hartford Hospital deadline looming, Anthem adds St. Francis to exchange network

St. FrancisSt. Francis Hospital and Medical Center in Hartford is joining Anthem Blue Cross and Blue Shield’s network for plans sold through the state’s health insurance exchange, ending the hospital’s holdout from the insurer’s Obamacare plans.

That means that as of Oct. 1, people who bought Anthem plans through the state’s exchange, Access Health CT, will be able to receive in-network coverage for care at St. Francis.

The timing is particularly important for Anthem: Hartford Hospital is slated to leave the insurer’s network next week if its parent company, Hartford HealthCare, doesn’t reach a deal on new contracts by Oct. 1. Without the St. Francis agreement, Anthem customers who bought their plans through the exchange would have been facing the prospect of not having either of the major Hartford-area hospitals in their network.

St. Francis already participates in most Anthem plans, but had opted against joining the network for the insurer’s exchange plans. That meant that people who bought Anthem plans on the exchange would have had to pay significantly higher out-of-network rates to go to St. Francis.

A St. Francis spokeswoman said the agreement announced Thursday applies to doctors employed by St. Francis, but that some doctors who admit to the hospital negotiate their own contracts with the insurer. She said patients with Anthem exchange plans should check to see whether their doctor accepts the coverage.

The agreement with Anthem covers Mount Sinai Rehabilitation Hospital, Collaborative Laboratory Services, and Saint Francis Behavioral Health Group.

With the addition of St. Francis, Anthem’s exchange network now covers all hospitals in Connecticut — although the relationship with the five Hartford HealthCare hospitals could change next week.

As of Wednesday, representatives for Anthem and Hartford HealthCare said they were still negotiating.

If the two sides don’t reach a deal, the five hospitals — Backus Hospital in Norwich, Hartford Hospital, MidState Medical Center in Meriden, The Hospital of Central Connecticut in New Britain and Southington, and Windham Hospital — would be out of Anthem’s network Oct. 1. That change would apply to all Anthem plans, not just those sold through Access Health.

Anthem is the state’s largest insurance company and has the most exchange customers of the three companies that offered individual plans through the new marketplace this year.

Comments

comments