Attorney General Tong Urges Scrutiny Of Unaffordable Insurance Rates

HARTFORD — Attorney General William Tong submitted comments to the Connecticut Insurance Department on Friday, August 15 seeking scrutiny of unaffordable rate hike requests from seven health insurers for plans available on the individual and small group market, both on and off the state-sponsored exchange. The comments also include an appendix of questions to insurers, probing their persistent failures to negotiate lower costs and control inflating billing, to justify their cost analyses, and to address efforts to align costs within Connecticut’s Healthcare Benchmark.

For the first time, this year’s hearings will also include representatives from the hospitals and pharmacy benefit managers, an important development in understanding and addressing runaway health insurance costs.

Collectively, the plans cover approximately 224,000 people in Connecticut. The proposed average individual rate hike request is 17.8 percent, compared to 8.3 percent last year. The proposed average small group rate hike request is 13.1 percent, compared to 11.9 percent last year. Year after year, insurers have sought rate increases that far exceed other inflationary and general economic growth measures.

Tong said, “Too many Connecticut families cannot afford health insurance and cannot afford to live without it. This is an utterly broken and unworkable system, and the costs — the monthly premiums, deductibles, coinsurances and copays, and the nickel and diming over fees — are only getting worse. It cannot continue like this.”

Tong continued, “These hearings this year are one of the first shots we’ve had to get insurers, hospitals, and pharmacy benefit managers in the same room to justify these skyrocketing costs, and to talk about what we need to do to make this affordable for Connecticut families and small businesses.”

In his comments, Tong zeroes in on the issue of provider up-coding and the absence of scrutiny and oversight by insurers, leading to increased insurance costs as well as higher patient cost-sharing. The comments note three such examples from individuals who complained to the Office of the Attorney General, including a patient who visited a hospital emergency department with no life-threatening symptoms but was billed for a severe level of care without even seeing a physician, a patient who visited a local urgent care center but was billed for service at a hospital emergency department, and a patient who was billed for both an office visit and a preventative care visit after her physician inquired about a fully resolved condition at her annual physical. The additional office visit code resulted in a substantial deductible charge for the patient when the annual physical should have been fully covered as a preventative service.

Tong’s comments also take insurers to task for failure to negotiate fees on an itemized basis. Pushed by Tong, insurers conceded during the 2023 rate hearings that they do not negotiate the cost of individual procedures with hospitals and providers at all. Tong has continued to push insurers and state regulators to address the broken incentive structure and negotiation dynamics between insurers and healthcare providers that contribute to the ever-rising cost of healthcare in Connecticut.