Hartford Hospital File Photo

Anthem Blue Cross and Blue Shield and the parent company of five Connecticut hospitals failed to reach a new contract deal by their midnight deadline, leading Hartford Hospital and four others to exit the network of the state’s largest insurer Wednesday.

That means that patients covered by Anthem will have to pay higher out-of-network rates if they seek care at one of the five hospitals owned by Hartford HealthCare — Hartford, The William W. Backus Hospital in Norwich, MidState Medical Center in Meriden, The Hospital of Central Connecticut in Southington and New Britain, and Windham Hospital. The Institute of Living and Jefferson House are also no longer in Anthem’s network.

Patients receiving prenatal care or active, ongoing treatment for a condition can request coverage to continue their care from a Hartford HealthCare provider by submitting this form to Anthem.

The lack of a contract does not affect emergency services provided at any of the five hospitals. Coverage of doctors who are part of Hartford HealthCare Medical Group is also not affected.

The brewing Anthem-Hartford HealthCare dispute has been closely watched by people in health care, who have viewed it as a sign of the new dynamics of the health care landscape. While contract disputes between hospitals and insurers have become common in recent years, this is the first to involve such a large hospital network and the state’s largest insurer.

Many Connecticut hospitals have joined larger hospital chains in recent years, which can give them more leverage in negotiations with insurers. Meanwhile, insurers are increasingly trying to tie health care providers’ pay to quality measures, not just to performing more services.

Most hospital-insurer contract disputes in recent years have been resolved before the deadline. In the cases that took longer, hospitals left the insurers’ networks for a brief period but ultimately returned.

Anthem spokeswoman Sarah Yeager said the company has sought to tie more of the hospitals’ pay to performance, and that the biggest sticking point in the talks was whether pay increases in the first year of the contract should be fully guaranteed or partly linked to performance.

“We have offered a fair and balanced renewal agreement under which 70 percent of the first year’s renewal increase (which exceeds the rate of inflation) would be guaranteed and 30 percent would be based on HHC’s performance on initiatives, such as reduction of congestive heart failure readmissions,” she said.

Yeager linked hospital payment rates to customers’ costs. The hospitals’ have received increases that outpace inflation for the past four years, she said, adding, “This is not sustainable.”

A statement from Hartford HealthCare said the company will continue working toward a deal with Anthem.

“We need Anthem to partner with Hartford HealthCare as we transition health care to a value-based model, which focuses on improving quality outcomes, lowering costs and improving access to care for the patients and communities that rely on us. Moving forward, it is our hope that Anthem will work in good faith to agree to a new contract,” the company said.

State Healthcare Advocate Victoria Veltri said last week that her office had already received calls from people who had started treatment and wanted to know how their coverage would be affected if the two sides didn’t reach a deal.

Veltri said she might seek legislation next year requiring a cooling-off period between hospitals and insurers if they can’t reach a deal. When contract disputes occur, Veltri said, patients get stuck in the middle.

“The consumers are in a no-win situation, and I would not like to see that repeated,” she said.

According to Hartford HealthCare, patients who were hospitalized before Oct. 1 but remain in the hospital after Wednesday will have their treatment covered as if the hospital were still in Anthem’s network. Routine post-surgical follow up care for patients who had surgery before Oct. 1 will also be treated as in-network, even if it occurs after Oct. 1.

The process for handling hospital bills for Anthem customers who use Hartford HealthCare facilities while they’re out of the network will be different, Hartford HealthCare said. The hospital will bill Anthem, which will then send the patient an explanation of benefits form and a check for the portion of the bill the insurer will pay. Patients must send the explanation of benefits form and check to Hartford HealthCare. Hartford HealthCare will then bill the patient for the difference.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

Leave a comment