Healthcare Advocate: Insurer, Hospital Contract Dispute Threatens System
Ongoing contract disputes between three large health insurance carriers and local health care providers threaten “the potential failure of an entire system of care east of the river,” according to a statement from Healthcare Advocate Victoria Veltri.
At issue are contracts regarding how much Eastern Connecticut Health Network and Eastern Connecticut Physicians Hospital Organization are reimbursed by carriers United/Oxford, Anthem and ConnectiCare.
“While it’s not uncommon for carriers and hospitals and carriers and physician organizations to engage in protracted negotiations, in this case there are three contracts in dispute at the same time,” she said.
Veltri said the hospital contract between United/Oxford and ECHN has already been terminated. Meanwhile the contract between ConnectiCare and ECPHO is an extension and the Anthem contract will expire at the end of the year, she said.
As a result patients in the area are confused about their access to care and providers may be left unable to participate with the three insurance companies, she said. Veltri called on all parties to get to work negotiating a resolution.
“Each party is responsible for delivering on the promises made to consumers for accessible, quality health care. Right now, accessibility is in serious question, particularly under the United/Oxford and Anthem contracts,” she said.
While the contracts being disputed are mostly for hospital based services, they also affect patients looking to get care at providers affiliated with the hospitals, she said.
Veltri said that United/Oxford has encouraged providers who work at Manchester and Rockville Hospitals to obtain privileges at other hospitals. She said that can be a difficult task.
“Obtaining privileges at other hospitals is not a simple practice. And for specialists, there are often concerns about ability to schedule OR time and pressure from other practices already affiliated with the hospital to prevent specialists from obtaining privileges, among other issues,” she said.
The disputes raises concerns about people who purchased insurance plans and expected to continue seeing their current providers, she said. For some that might not be possible but they will still be paying their monthly insurance premium, she said.
Veltri said the disputes could also impact providers because the carriers have all said they may no longer be able to see patients on an in-network basis.
“I’ve been told by multiple ECHN /ECPHO providers that their contracts with United/Oxford, Anthem and ConnectiCare amount to up to 80 percent of their practice volumes,” she said. “Each of these provider offices is a small business, the viability of which may be called into question because of the contract uncertainties.”
Veltri said that, though she can’t get involved with contract discussions, she will be available to help get negotiators to the table.
ECHN spokeswoman Rosemary Martocchio said the network welcomed Veltri’s concern and has been working with other state officials including lawmakers and the attorney general to move closer to an agreement.
“ECHN continues to have productive conversations to renew contracts with several insurance carriers, and we remain focused on coming to agreement as soon as possible for the benefit of our patients and physicians,” she said in a statement.
However, Martocchio said ECHN is concerned that inadequate reimbursements will affect patient care over time.
Currently, the network is not participating in United/Oxford plans but is participating in in-network United/Oxford Medicare plans, she said.
“ECHN will not turn anyone away who presents for care regardless of their insurance coverage or ability to pay,” she said.
Veltri said this year has seen many high-profile contract disputes between insurance companies and hospitals, a fact that highlights the need for reform. Everyone involved should remember the patients while they are negotiating the monetary value and structure of contracts, she said.
“The bottom line is that we are really deciding is whether a cancer patient can continue to access his care with the oncologist he’s worked with for years, whether a woman in the late first trimester of pregnancy can continue care with the OB-GYN she’s seen for five years or whether a patient with a serious mental illness can maintain his relationship with his long-term psychiatrist,” she said.
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