11 Questions: What Does Hartford HealthCare-Anthem Dispute Mean For Patients?

Oct. 02--Tens of thousands of people in Connecticut could face higher health care costs due to the ongoing impasse between the state's largest health care network, Hartford HealthCare, and Anthem Blue Cross and Blue Shield, one of Connecticut's largest insurers.

Here are the answers to some common questions patients might have:

What happened?

Hartford HealthCare and Anthem Inc. failed to reach an agreement on a new contract by Sept. 30. As a result, Anthem customers are now considered out-of-network patients at Hartford HealthCare facilities and may face higher out-of-pocket costs for treatment.

Who is affected?

Anybody who has Anthem insurance and receives treatment at any Hartford HealthCare facility. According to estimates, about 60,000 people in the state could face higher costs for health care.

What hospitals and facilities are included?

Hartford Hospital, the Hospital of Central Connecticut in New Britain and Southington, Midstate Medical Center in Meriden, Backus Hospital in Norwich, Windham Hospital.

What about emergencies?

Hartford HealthCare said patients with "true emergency conditions" can receive treatment at any of their facilities and pay the in-network rate.

What if I am pregnant or undergoing treatment for an ongoing condition?

Anthem said certain customers may be eligible for "Continuation of Care" benefits, where they will continue to pay in-network rates for treatment. These benefits typically apply to cancer patients and pregnant women in their second or third trimester.

Medical conditions that normally qualify for continuation of care include:

* Patients in an inpatient setting receiving treatment for acute medical conditions;

* Patients with the diagnosis of cancer receiving surgical or radiation therapy;

* Patients with acute trauma, e.g., trauma/bone fracture care;

* Patients receiving short-term/cyclic chemotherapy;

* Patients receiving immediate post-hospital or post-surgical care;

* Patients with chronic medical conditions for which they are receiving active treatment; and

* Patients who are in their second or third trimester of pregnancy or the postpartum period.

Medical conditions that normally do not qualify for continuation of care include:

* Patients with stable chronic conditions for which there is not active treatment;

* Patients with short-term self-limiting diseases, e.g., muscle injuries, bronchitis;

* Patients scheduled for elective surgery; and

* Patients in the first trimester of pregnancy.

Customers can apply for continuation of care benefits by calling the phone number on the back of their insurance card or by visiting http://group.anthem.com/HHC

Should I reschedule elective surgeries or other procedures?

Anthem says "not necessarily," and asks customers to complete a continuation of care form first. If after a review it's determined the procedure does not qualify for continuation of care, "we'll help you find a hospital that fits your needs," Anthem says.

What about a follow-up visit for a surgery that occurred before Oct. 1?

Routine post-surgical follow-ups will be covered as in-network if the surgery happened before Oct. 1, according to Anthem.

What if I was hospitalized before Oct. 1 and discharged on or after that date?

All services you received will be billed as in-network if you were admitted prior to Oct.1.

What changes with billing?

Patients will receive bills directly from Hartford HealthCare for the services they receive. Anthem said it will make any claim payments directly to customers, who will be responsible for paying their bills in full.

What are Hartford HealthCare and Anthem doing now?

The two sides are continuing to negotiate, but it's not known when a new agreement will be reached. Anthem says they will help Hartford HealthCare customers transition to in-network providers. Hartford HealthCare is urging customers to consider switching insurance carriers during the upcoming open enrollment period.

When will an agreement be reached?

There's no telling. Three years ago, during a similar dispute, Hartford HealthCare and Anthem reached an agreement two days after the previous contract expired and it was retroactive to when that contract lapsed, meaning there was no gap for in-network coverage.

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