Lawmakers urged to prevent insurance contract disputes
By SUSAN HAIGH
Nov. 28, 2017
HARTFORD, Conn. (AP) — Connecticut lawmakers were urged Tuesday to consider ways to possibly avoid or mitigate any future contract impasses between insurance companies and health care systems, like the seven-week dispute between Hartford HealthCare and Anthem Blue Cross Blue Shield that affected tens of thousands of residents.
"We need to do something because we need to head off future difficulties and disruption," said state Healthcare Advocate Ted Doolittle, who said his office received "many, many dozens" of complaints from Anthem customers, some of whom didn't know there was a dispute until their medical procedure was canceled.
The now-settled impasse left thousands of patients out-of-network. They faced higher out-of-pocket costs, interrupted medical procedures, and general anxiety and confusion about their coverage.
Suggested ideas for alleviating problems include instituting a cooling-off period, where old rates would remain until an agreement is reached; having the state set hospital rates; basing rates on a particular hospital's costs and not those of an entity's entire group of hospitals; and creating a new binding arbitration system, where disputes could be settled by an outside party.
The General Assembly is expected to consider possible legislation stemming from the dispute when the next regular session begins in February.
"I think this committee has a job, after this debacle," said Rep. Matthew Lesser, D-Middletown, a member of the Insurance and Real Estate Committee, which held hearings on Tuesday.
The state's Insurance Department is currently reviewing what other states are doing to prevent similar impasses. Some speakers suggested that lawmakers review how efforts to regulate prices in Maryland, Rhode Island and Massachusetts have worked.
Hartford HealthCare and Anthem announced on Nov. 18 a deal on a new, three-year contract after failing to achieve an agreement on Sept. 30. Representatives from both entities apologized at Tuesday's hearing for the disruption, noting it was a rare occurrence.
"I have no desire or intention to repeat this again. We've got to figure it out," said James Cardon, executive vice president of integrated health partners at Hartford Healthcare.
Deremius Williams, vice president of provider solutions at Anthem in Connecticut, insisted the insurer was advocating for Anthem customers during the protracted talks. But she acknowledged "we do need to plan ahead together" for future negotiations in order to avoid similar disruptions.
Democratic State Comptroller Kevin Lembo, who oversees the Anthem health insurance plan for state employees, predicted disputes will happen again given how health care and health care financing is changing. More hospitals and other providers are being purchased by big groups such as Hartford Healthcare. Anthem is about to begin talks with another major provider, Yale New Haven Health.
Lembo said the time has come for statewide patient protections.
"There's got to be some learning we can take away from this and potentially some role for the legislature to put some guidance, regulation in place to help at least drive the parties toward a reasonable and timely outcome," he said, adding how there should be a way to "spur the conversation forward, to get folks to the table, to mandate mediation, hold out the specter of arbitration."
Senate President Martin Looney, D-New Haven, said he plans to resurrect a bill he first proposed in 2015 that requires binding arbitration to resolve disputes between hospitals and insurers when both fail to reach an agreement. Connecticut Insurance Commissioner Katharine Wade, however, warned that forcing binding arbitration "may actually cause rates to be higher" compared to allowing the two sides to finally reach an agreement.
"That being said, there is opportunity to improve the process," she said. "I'm not suggesting it is a perfect process by any stretch of the imagination."