Anthem Blue Cross Blue Shield is notifying thousands of local people that come next month, they may need to go somewhere other than the Hospital of St. Raphael — or forgo insurance.
Anthem, the state’s largest insurer, has been mailing letters to that effect this week to to all people covered by its plans who live within 15 miles of St. Raphael’s.
The letter stems from a notice St. Raphael’s sent Anthem, informing it that it intends to “terminate its participate hospital contract.”
Hospitals are supposed to give insurers that notice within 30 days of a contract expiring. The two sides have been trying to negotiate reimbursement rates under a new contract — and failing.
If they don’t come to terms by March 30, the contract is over starting April 1. And most Anthem patients would need to go to other hospitals if they want to be covered.
David Sepulveda Photo
Thousand of people’s jobs and health care are at stake, noted New Haven State Rep. Pat Dillon (pictured).
“People will have fewer choices and will lose continuity of care if their doctor is based at St Raphael’s” if the two sides don’t reach a last-minute deal, she said.
Anthem mailed a flyer with 15 questions and answers about what the termination would mean for patients.
People will still be covered for emergency visits to the hospital. Pregnant women in their second and third trimesters can still have their babies there and receive post-partum care. The insurer will continue to cover routine post-surgery care for operations that take place before April 1. Same with care for hospitalizations that begin before April 1.
Otherwise, Anthem offered a list of 10 other hospitals within 30 miles of St. Raphael’s where it continues to cover patients.
Anthem stated that it hopes either to reach agreement with the hospital before the deadline and thereby avoid having the termination take effect, or resume a relationship in the future.
Anthem spokeswoman Sarah Yeager echoed that line in a written statement in response to a request for comment.
“The Hospital of Saint Raphael has terminated its participating hospital contract with Anthem Blue Cross and Blue Shield,” Yeager stated. “Anthem has been working with the hospital in good faith, but to date, Anthem and the Hospital of Saint Raphael have not reached agreement on the terms of a contract renewal…
“Anthem maintains a very broad, robust network of hospitals and other participating providers. There are several hospitals within close proximity to the Hospital of Saint Raphael that are available to members for both emergency and non-emergency care if the contract expires.”
St. Raphael’s, too, responded to questions with a terse written statement. Neither side would say how many patients the termination would affect.
“Saint Raphael’s and Anthem have a long-standing, collaborative relationship and fully anticipate reaching an agreement prior to April 1. In the meantime, the notification has no impact on current patients who are Anthem subscribers. The scheduling of tests, procedures or admissions is unaffected,” hospital spokeswoman Liese Klein stated in a written response.
“These negotiations are important to ensure that the Hospital of Saint Raphael is paid fairly for the care it provides. Reasonable, market-competitive rates are critical to our ability to offer the advanced technology, top-level staff and comprehensive services that patients and physicians have come to expect when choosing Saint Raphael’s.”
Larger Pressures
Last year Middlesex Hospital sent a similar 30-day termination notice to Anthem, complaining Anthem kept lowering reimbursement rates, but then the two sides reached an agreement.
Connecticut Hospital Association spokeswoman Leslie Gianelli said her group doesn’t want “to get int he middle of this.”
“We think this is a situation that’s best left between the hospital and the insurer,” she said. “We don’t want to comment on it.”
Look for more of these last-minute notices about possible pending contract negotiations between hospitals and insurers, state Healthcare Advocate Kevin Lembo said.
He said that the underlying reasons for the increasing difficulty in talks can’t be solved by individual insurers and hospital at the negotiating table. Hospitals like St. Raphael’s have legitimate concerns about unfair treatment by large insurers that dominate the market, he said. “Pent-up feelings and realities come pouring out at the negotiating tables.” Anthem is the state’s largest insurer by far, covering 1.5 million people, he said. Next comes United Healthcare with about 670,000 people covered, then Aetna, with 320,000.
State Rep. Dillon said she’d like the state to get involved in the dispute in two ways. She’d like regulators to examine “insurers’ behavior” (“Insurers are jawboning providers like St Raphael’s to drive down rates at the same insurers are jacking up premiums. It appears to be profit driven”). And she’d like the government to revisit how urban hospitals and Catholic hospitals like St. Raphael’s get reimbursed.
“Many hospitals have no breathing room, and Catholic hospitals are especially hard hit,” Dillon said. “They are all in inner cities,” have more patients on government health care assistance, and get lower reimbursements than non-religious hospitals do for mental health treatments. Dillon faulted legislators for not acting to bring Catholic hospitals’ rates up to par and the Rell administration for not acting on a bid to raise reimbursements for State-Administered General Assistance [SAGA] patients by include them in the state’s Medicaid plan [and thus receive more federal reimbursement].
Click here to about some of the financial pressures hitting St. Raphael’s.
“When there were 1,000 jobs at stake at Pratt Whitney, state policymakers paid attention, and rightly so,” Dillon noted. “St. Raphael’s has 4,200 workers. What is the plan?”
I have received excellent care at St. Raphael's, and I appreciate the Hospital's constructive relationship with its community. Anthem is a bear to do business with. Their CEO has an exorbitant salary, the rates for subscribers have just been raised, and now they propose reducing services in the area. I was very angry when I received the letter from Anthem - some of the exorbitant fees I pay are being used to fund this mass mailing - a bully tactic to hurt the reputation and standing of an important community partner during "negotiations." Anthem has no shame. I wish there was a public option for health insurance; the private companies are irresponsible monopolies.