Anthem Blue Cross and Blue Shield of Connecticut is in a standoff with several Connecticut health care organizations over compensation rates, which could force the termination of several existing relationships.
Anthem has been negotiating with Bristol Hospital for a new contract for more than a year, but has failed to reach an agreement. If both sides don’t reach a middle ground then effective Nov. 1, Bristol Hospital will no longer be a participating hospital with Anthem.
Meanwhile, talks are also stalling between Anthem and Hartford Healthcare, the state’s largest hospital network that includes Hartford and Windham hospitals.
Over the past several months, Anthem and Hartford Healthcare have been in talks to renegotiate contracts for Hartford and Windham hospitals, but both sides have been unable to reach an agreement.Â
According to Anthem spokeswoman Sarah Yeager Hartford Healthcare has notified Anthem of its intent to terminate its participating hospital contracts for Hartford Hospital and Windham Community Memorial Hospital with Anthem effective Oct.31 if the two sides fail to come to an agreement.
Both terminations threaten health coverage for numerous Anthem consumers who may depend on Bristol Hospital for treatment.
Hartford Healthcare officials did not immediately respond for comment.
In a statement Anthem said it “has proposed increases to both hospitals that would continue to provide them with reimbursement at a margin over their costs. Anthem is seeking an agreement with the hospitals that will allow our members access to quality health care, while trying to manage the cost of health care and rising premiums.Â
“Any increase agreed to by Anthem will be experienced by employer groups and members in the form of increased premium payments and member coinsurance. Our responsibility to our customers will not allow us to increase this burden to the degree currently being requested by the hospitals.”
The Hartford Business Journal reported earlier this year that hospitals and private insurers were likely headed for prolonged and tense negotiations over reimbursement rates because of the economy and federal health care reform.
Many in-state hospitals are getting squeezed on Medicaid and Medicare reimbursement rates as the federal government reins in spending so it can expand insurance coverage to millions of uninsured Americans.
Hospitals are also seeing fewer insured patients because of the economy and their investments portfolios have also taken a beating.
At the same time, health insurers are facing intense pressure to rein in rate increases, which is forcing them to be tougher on negotiations with physicians and hospitals.
Health insurers are demanding that hospitals and doctors provide more efficient care to help reduce costs.
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