CT hospital, health insurer ink coverage contract. What it means for patients.

After weeks of contentious talks, a high-profile insurer and a major health care provider in Connecticut reached a 3-year agreement that will keep in place coverage for as many as 15,000 patients, nearly three months after the existing contract expired.

Hartford-based Aetna said it has signed the new agreement with UConn Health in Farmington, an arm of the University of Connecticut, that is effective March 1. The current agreement expired Nov. 30.

In a brief statement, Aetna, owned by health care giant CVS Health Corp., said the agreement with UConn Health restores "in-network" access for its commercial -- primarily through employer-sponsored plans -- and Medicare Advantage members for seniors.

"This new agreement ensures continued access to high-quality, convenient care while helping control health care costs for Connecticut families, local employers, and retirees," Aetna said, the statement. "Aetna members can confirm their individual plan benefits and network by visiting the Aetna website or calling the phone number on their member ID card."

Although the previous contract expired at the end of November, some patients covered by Aetna did not lose their "in-network" status until Feb. 1. Others lobbied for an extension until March 1.

Without a contract between provider and health insurer, patients may find themselves suddenly "out-of-network" and facing significantly higher out-of-pocket costs for being treated by the same physician or other health provider. The shift also can set off a scramble to find doctors or specialists that accept the patient's insurance.

In a statement, UConn Health said the agreement ensures continued access to UConn Health's academic medical center, specialty services, and community-based care sites across the state. It also reflects a shared commitment to maintaining access to high-quality care for Connecticut residents.

"After spirited negotiations, we are pleased to have reached new contract terms that ensure our patients the access they need and our UConn providers the reimbursement they deserve," said John Driscoll, chair of UConn Health's board of directors.

With the new agreement in place, UConn Health said both organizations move forward with a renewed partnership centered on patient access and long-term sustainability.

At issue in the contract negotiations are the reimbursement rates for services that Aetna covers at UConn Health -- the parent of John Dempsey Hospital, a network of clinics and more than 700 providers.

Early on in the contract talks that began before the previous contract expired, both Aetna and UConn Health lobbed public accusations that each other was not presenting reasonable proposals. UConn Health said its reimbursement rate was among the lowest for hospitals in Connecticut.

"This agreement supports fair reimbursement for the high quality of care and service we provide. We are delighted that our Aetna patients will continue to have access to that care." Dr. Andrew Agwunobi, UConn Health's chief executive, said.

Both Aetna and UConn Health declined to comment on the agreed-upon reimbursement rate. UConn Health confirmed the length of the new agreement.

UConn Health encouraged Aetna members who deferred care to reconnect with their providers to ensure their healthcare needs are addressed without delay.

Experts say tense negotiations between health insurers and health systems over coverage are becoming more common across the country.

On the one side, there are hospitals and health systems facing sharply rising costs for labor -- especially with the shortage of trained nurses -- pharmaceuticals and other supplies. On the other side, are the health insurers who are under pressure to keep increases in premiums -- particularly for employer-sponsored plans -- in check, with an eye toward their own corporate profitability.

Negotiations also are becoming increasingly public. Both sides are going to the media and directly to the public to sway patient -- and public -- opinion, experts say.

UConn Health took out billboards along major highways in Connecticut, part of its strategy to pressure Aetna in the negotiations.

Kenneth R. Gosselin can be reached at [email protected].

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