Lengthy Healthcare Insurance Dispute Sows Confusion Among Patients


As the contract stalemate between Hartford HealthCare and Anthem Blue Cross Blue Shield drags on, patients such as Racine Mills-Miller, a Hartford resident who had a heart transplant in 2013, are left with growing concern about coverage, cost and access.

Mills-Miller said she is waiting for Anthem to respond to her Oct. 2 request to continue critical treatment and receive the in-network rate. She said she canceled an Oct. 19 doctor’s appointment and rescheduled it for Nov. 2.

“It’s a big ordeal so I need to know if I’m covered,” Mills-Miller said, referring to doctor’s visits that can stretch out for an hour or 90 minutes.

She said Anthem told her it will take 15 days to review her application for continuation of care, but that deadline has passed. Sarah Yeager, a spokeswoman for Anthem, did not have information about Mills-Miller’s application, but said Anthem complies with state insurance requirements for timely responses.

The dispute between Hartford HealthCare and Anthem Blue Cross Blue Shield is now three weeks old, affecting as many as 60,000 patients in Connecticut. The stalemate defies predictions of a quick resolution typical of earlier negotiations. Without an agreement, Anthem customers are now considered out-of-network patients at Hartford HealthCare facilities and may face higher out-of-pocket costs for treatment.

Patients with “true emergency conditions” can receive treatment at any Hartford Healthcare facilities and pay the in-network rate.

Wading through information about health insurance deductibles, co-pays, what’s covered and what isn’t is complicated under ordinary circumstances. The absence of a contract since Sept. 30 between Hartford HealthCare and Anthem is not ordinary, and tens of thousands of patients are forced to figure out what’s available while relying on information that some say is sketchy or contradictory.

“It’s not only not transparent, but it’s secret,” North Granby resident Susan Nagy said of the lack of information.

She said she and her husband are unsure if his heart doctors are part of a physicians group affiliated with Hartford Hospital, one of the hospitals that is part of Hartford HealthCare. If so, it would be out of network, and patients would be forced to pay higher costs and more fees.

Lack of information preceded the breakdown in talks between Hartford HealthCare and Anthem, Nagy said.

“I didn’t know what the new premium was until the bill came in in January,” she said.

Nagy said the delay complicates decision-making in advance of open enrollment, which begins Nov. 1. Patients may wonder “whether or not the Hartford Hospital group is participating in Anthem for 2018,” she said.

Yeager said the insurer hopes to have an agreement in place before Nov. 1.

Hartford Healthcare spokesman Shawn Mawhiney said Friday the two sides remain “far apart” in negotiations.

Hospitals affected by the dispute include Hartford Hospital, the Hospital of Central Connecticut in New Britain, MidState Medical Center in Meriden, Backus Hospital in Norwich, Windham Hospital in Willimantic and the Institute of Living, a Hartford-based facility that treats mental illness and other health conditions.

Wanda Prorok of South Windham, who has a heart condition that could lead to a stroke, is worried that she could end up going to Manchester Memorial Hospital, more than 20 miles from home. She would also have to work with a different doctor “who doesn’t know my history.”

She said she found out nearly a week after the Sept. 30 deadline between Anthem and Hartford HealthCare passed that the two nearest hospitals — Windham and Backus — are out of network.

“They didn’t exactly go out of their way to let people know what’s going on,” Prorok said.

Mawhiney said it’s the “first such complaint we have heard of this nature.” He apologized and said Hartford HealthCare is doing its best to keep patients informed.

In addition to letters the Hartford HealthCare sent to patients, it launched a website, hartfordhealthcare.org/anthem, and bought newspaper ads in Connecticut to inform patients.

Because Anthem and Hartford HealthCare are private, state involvement is limited. The Department of Insurance gets a “handful of calls” daily, spokeswoman Donna Tommelleo said.

The agency is in regular contact with Anthem to make sure legal rules for continuation of care are followed, including expedited reviews for medically urgent care, Tommelleo said.

State Healthcare Advocate Ted Doolittle said his office has “seen an uptick in calls,” particularly as patients get closer to planned surgeries.

“I 100 percent agree that information is not as good as it should be,” he said.

His office is in regular contact with Anthem and Hartford HealthCare for information, he said, that helps with advice to consumers who call. The inconclusive negotiations are taking a toll on patients, causing anxiety about health care availability and cost, he said.

Mary Potter of Southington said she and her husband are covered by Medicare, which she said was confirmed by Hartford HealthCare. But she said her doctor’s office disagrees.

“I can walk in there today and be covered,” she said. “They think I’m not.”

Doolittle, the healthcare advocate, said the confusion could be about plans that include Medicare Advantage Part C, which provides additional health care coverage.

Potter said patients may be canceling appointments “partly because a medical office receptionist does not have the correct information about the issue.”

“The fine details have to be communicated to everyone downstream,” she said.

Source link

Lengthy Healthcare Insurance Dispute Sows Confusion Among Patients

Tags: #Healthcare #Healthcare Info #Healthcare News #Healthcare Recipe #Healthcare Trick #Healthy Lifestyle