Lawmakers Urged To Take Action In Health Insurance Disputes

Nov 28, 2017

Lawmakers are trying to probe a solution to disputes between health insurers and health care providers, following the recent seven-week breakdown between Anthem and Hartford HealthCare.

Thousands of patients were left either delaying care, or with higher medical bills during the dispute, which centered around reimbursment rates for a new three-year contract.

Lynne Ide of the Universal Health Care Foundation of Connecticut told legislators at a public hearing that she’s heard many horror stories - including one from a physician in eastern Connecticut.

"One of his patients showed up at the emergency room at Windham Hospital, and then was admitted," said Ide. "She just didn't know what was going on with this controversy between the two entities. She ended up getting a $13,000 medical bill."

In testimony before the legislature’s Insurance Committee, Ide said patients were left without options, because Hartford HealthCare owns so many facilities.

"This situation that happened this fall is the direct result of increased consolidation in the industry in our state," she said. "That is something that our state has allowed to happen. And therefore, we believe that the state does have a responsibility to step up and mitigate these kind of situations happening in the future."

Lawmakers have been asked to consider passing legislation that would require companies to enter binding arbitration in such disputes. Other suggestions included more regulation of hospital rates, or fewer mandates on health insurers to allow them to offer cheaper plans.

Representatives of both Anthem and Hartford HealthCare were on hand. Both apologized for the disruption to patients.

Hartford HealthCare’s Dr. James Cardon told the panel his employer was right to hold out for better reimbursement.

"We've managed to eke out a very slim operating margin over the past years at Hartford HealthCare, which are so critical for us to continue to reinvest and be sustainable," he said. "There are significant consequences to not receiving fair payment. We deliver care locally. If revenue is not supporting of what we're trying to do, we can't pick up and move to a more favorable zip code."

Anthem's Deremius Williams claimed that such lengthy contract disputes are not the norm.

"Network disruption is rare. It is the rare exception and not the rule," she said. "We have typically been able to resolve our differences."

But State Comptroller Kevin Lembo argued strongly that more regulation and oversight is needed in any case, to ensure customers don't suffer as a result of future disputes.

"We need to start having a conversation that doesn't just fall back on - it's the private market, and economic factors," he said. "The pressure point in those negotiations are patients, patients and their families, so that's what you're risking when you allow it to just play itself out."