CT health system's contract with insurer has expired. What patients need to know about their coverage.
Farmington-based UConn Health's contract with insurer ConnectiCare expired Tuesday with the two sides still at odds in negotiations over a new agreement, raising the possibility that patients covered by the health insurer could lose their 'in-network' status with the health system's hospital, clinics and doctors.
The negotiations between UConn Health — the parent of John Dempsey Hospital, a network of clinics and more than 600 providers — and ConnectiCare are focused on the reimbursement rate for services. UConn Health said its rate is the lowest, behind all hospitals in Connecticut, despite revenue growth in the last decade and rankings that place it in the top tier of hospitals nationwide.
'It's important that we receive fair compensation for the amazing services we provide,' Dr. Andrew Agwunobi , UConn Health chief executive said, in an interview. 'Our situation is that the payment is so low, it's unfair to providers, patients and taxpayers in Connecticut.'
The contract negotiations cover ConnectiCare's commercial coverage, which includes employer-sponsored plans, and Medicare Advantage plans, which are sold by private insurers and offer Medicare coverage plus additional benefits.
Even though the current contract has expired, the two sides are now entering a 60-day 'cooling off' period that concludes June 14 in which patients with ConnectiCare coverage with remain in-network. Contract negotiations will continue with the goal of reaching an acceptable agreement with ConnectiCare, Agwunobi said.
In a letter to The Courant, Farmington resident Felicia DeDominicus wrote that she was distressed about the potential end of coverage because her parents, who are 87 and 89, receive nearly all their medical care through the health center.
'My parents' [UConn Health] providers truly care about them, and we feel that caring,' DeDominicus wrote. 'We all trust these compassionate doctors at this vulnerable time in my parents' lives.'
DeDominicus urged all patients of the health center to voice their concerns about the possible loss of coverage, noting that losing coverage at the hospital would be devastating to her family.
'ConnectiCare should pay UConn Health fairly for the world-class doctors and the care that they provide,' DeDominicus wrote.
If a patient is forced out-of-network, the implications could be far-reaching.
According to healthinsurance.org, depending on the health plan 'expenses incurred for services provided by out-of-network health professionals may not be covered at all unless it's an emergency. Or they may be covered but with higher out-of-pocket costs than the member would pay for same care received from an in-network provider.'
In addition, 'the federal cap on out-of-pocket costs only applies to in-network care (and only care that's considered an essential health benefit). So out-of-pocket costs for covered out-of-network care can be much higher, or even unlimited. And, it's important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share.'
Consumers who find themselves out-of-network may be forced to find new health care providers that are in-network.
UConn Health said there can be exceptions for 'continuing care' such as chemotherapy treatments that remain in-network even in the absence of a contract.
ConnectiCare, headquartered in Farmington, was acquired by California-based Molina Healthcare on Feb. 4. Both ConnectiCare and Molina did not respond to emails Tuesday seeking comment.
UConn Health — an arm of the University of Connecticut — also oversees the university's medical and dental schools, plus its medical research. In the current fiscal year, UConn Health received about $193 million in state funding, or 12.5% of its total budget, Agwunobi said.
A standoff between hospitals and health insurers is not unusual in negotiations.
In December, for instance, Trinity Health of New England reached an 11th-hour contract agreement with Aetna, owned by CVS Health Corp., to continue in-network coverage.
Kenneth R. Gosselin can be reached at kgosselin@courant.com.
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