Insurance contract issue disrupts care for thousands of patients - WFSB 3 Connecticut

Insurance contract issue disrupts care for thousands of patients

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(WFSB file) (WFSB file)
(Hartford Healthcare) (Hartford Healthcare)

A contract dispute between an insurer and a healthcare provider has gone on long enough to garner the attention of some of the largest employers in the state.

State Comptroller Kevin Lembo, Mohegan tribal Chairman Kevin Brown, West Hartford officials and others wrote a letter to the presidents of Anthem Blue Cross and Blue Shield of Connecticut and Hartford Healthcare.

The contract dispute entered its 5th week this week.

Due to the missed deadline, state patients insured through Anthem are considered out-of-network and now face higher out-of-pocket costs.

“What patients want is to be able to see their doctor and after 38 days and all of the uncertainty and cancer patients and joint replacement patients and pediatric patients and people who are waiting to see their doctor, that uncertainty at a time when you are sick is really inexcusable," Lembo said.

"On behalf of some of the largest employers in Connecticut and the region, with approximately 300,000 covered lives, we urge an immediate end to the ongoing disruption to health care access that has resulted from Hartford Healthcare's and Anthem's failure to resolve this contract dispute in a timely and responsible fashion," the letter read.

The letter continued to say that its authors expected a resolution that improves health care quality and access that's affordable for patients and employers.

"It is in everyone's collective best interests, including your own, to immediately return to the negotiating table and resolve this dispute once and for all," it said.

The letter said the impasse is threatening health care access and causing financial distress for thousands of people.

In response to the letter, Hartford Healthcare said "We share concerns about patients getting caught in the middle, and the disruption it is causing. We are concerned about how far apart we remain in these negotiations. Hartford HealthCare needs to be paid fairly by Anthem so we can continue to provide the residents of Connecticut access to the high quality and coordinated healthcare they deserve. Other insurers understand this and partner with us. Only Anthem refuses to pay its fair share."

It said frustrated customers are considering other health care options.

Lembo and the others who wrote the letter said they are continuing to help people affected by the dispute find alternative providers.

"As you surely know, once patients connect with new providers, there is a good chance they will never return to their former providers," the letter said.

It ended by urging an end to the deadlock.

In response to issues patients are currently having, Hartford Healthcare said "We totally understand how frustrating and disruptive the negotiations have been for patients. We have been educating patients about Anthem’s Continuation of Care process. If Anthem approves, patients’ care is covered. Anthem controls the review and approval process. The other option is for patients to change insurance companies during open enrollment, as we have agreements with all major insurance companies except Anthem. For a continuation of care form or a list of insurance companies that Hartford HealthCare is in network with, click here."

On Tuesday evening, Channel 3 spoke to a local family that is deeply affected by the healthcare battle.

“I really expected this was going to be resolved by now,” said Candace Joseph, of Broad Brook.

It’s been a tough few weeks for Candace Joseph of Broad Brook and her 21-year-old son.

After having mesh hernia surgery last year, her son has ongoing chronic pain issues.

The search to find some relief wasn’t easy, and after going to doctor after doctor, they finally found the one.

“This guy is great. He is very personable. He’s very thorough,” Joseph said.

Last month, everything changed after Joseph learned her son’s doctor was now considered out-of-network.

It’s all thanks to Anthem Blue Cross and Blue Shield and Hartford Healthcare failing to come to a contract agreement.

That means each visit would now cost them a whopping $300.

“So all of us innocent parties who just happen to be members of Anthem are a victim of this,” Joseph said.

She added that she even tried to apply for what’s called a “continuation of care” so her son could see the same doctor, but her request was denied.

“They claim there are other doctors within the network that provide the same type of care but once you have gone through all these doctors and finally find someone who helps you, you want to continue with that person,” Joseph said.

While her son’s doctor and many others didn’t anticipate this dispute lasting longer than two weeks, we’re now at week five with no end in sight.

 “My son deserves a good life and deserves to be healthy and pain free. He doesn’t deserve to have to jump through hoops to try to get through every day,” Joseph said.

State Reps. Gregg Haddad (D-Mansfield), Susan Johnson (D-Windham), Linda Orange (D-Colchester), Michael Winkler (D-Vernon) and Senator Mae Flexer (D-Killingly) urged Hartford HealthCare and Anthem Blue Cross and Blue Shield to "redouble" their "efforts to come to an agreement.” 

“The effect that your inability to come to agreement has on many insured residents is worsening each day. This is true not only for people who have had to have surgery out-of-network, and also for people who are unable to change insurance companies due to geographic constraints,” the lawmakers said in a joint statement on Tuesday. 

The lawmakers sent a letter to both Anthem Blue Cross and Blue Shield of Connecticut President Jill Hummel and Hartford HealthCare Chief Executive Officer Elliot Joseph. To read the full letter, click here

“Many of our constituents are struggling financially, and this contract dispute has left them less secure. While Hartford HealthCare and Anthem have reaped hundreds of millions of dollars in profits over the past few years, our constituents are struggling to make ends meet,"  Haddad said in a statement on Tuesday. 

“Anthem is one of the nation's largest health benefits companies and in fiscal 2014 Hartford HealthCare reported $103 million in profit margins on $2.5 billion in revenue. It’s time they stop sacrificing our constituents and bargain with everyone’s interests in mind,” Orange said in a statement on Tuesday. 

“The ongoing contract dispute threatens to severely disrupt the health care of Windham residents who rely on Windham Hospital. Worse still, the burden will fall the hardest on those individuals and families struggling to get by, who may not have the resources to access medical services outside our region,” Johnson said in a statement on Tuesday.  

“The healthcare of Connecticut residents should not suffer because of Anthem and HHC’s inability to reach an agreement. My colleagues and I are calling on you to sit down at the table and reach an agreement. Connecticut residents are not part of your negotiation, they should not suffer because of it, and they should not be treated as a bargaining chip. So please, get back to work, reach an agreement and end this stalemate,” Flexer said in a statement on Tuesday. 

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