If CT health system doesn't reach contract agreement with insurer, what it could mean for patients

Trinity Health of New England was still at odds in contract negotiations with health insurer Aetna just four days before the current agreement is set to expire, raising the worrisome possibility that many patients insured by Aetna will lose their "in-network" status with the health system's hospitals and doctors.

The negotiations between Trinity Health -- the parent of St. Francis Hospital in Hartford, three others in Connecticut and one in Springfield -- and Hartford-based Aetna are focused on reimbursement rates for services. Trinity Health, on its website, says those reimbursements do not adequately cover the "true cost of care we provide."

"Yet, Aetna keeps raising premiums and out-of-pocket costs for its members, to boost their profits, which topped $5.6 billion in 2023," Trinity Health argues on its website.

The contract negotiations cover Aetna commercial coverage, which includes employer-sponsored plans, and Medicare Advantage plans, which are sold by private insurers and offer Medicare coverage plus additional benefits.

Aetna is owned by Woonsocket, RI-based CVS Health Corp.

If a patient were forced out-of-network, the implications could be far-reaching.

According to healthinsurance.org, depending on the health plan "expenses incurred for services provided by out-of-network health professionals may not be covered at all unless its an emergency. Or they may be covered but with higher out-of-pocket costs than the member would pay for same care received from an in-network provider."

In addition, "the federal cap on out-of-pocket costs only applies to in-network care (and only care that's considered an essential health benefit). So out-of-pocket costs for covered out-of-network care can be much higher, or even unlimited. And, it's important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share."

Consumers who find themselves out-of-network may be forced to find new health care providers that are in-network.

In a statement Friday, Aetna acknowledged the fast-approaching Dec. 31 deadline.

"We are hopeful that we will reach an agreement that keeps them in our networks, while keeping health care services affordable for our members and health plans sponsors," Aetna said.

On Friday, Trinity Health said it is committed to working with Aetna to reach an agreement that "appropriately covers the true cost of care we provide to our patients."

"As a not-for-profit organization, rising supply and labor costs have made it difficult to maintain the high-quality of care patients deserve," the health system said, in a statement. "Trinity Health of New England relies on fair payment to provide the care and services patients depend on and need."

Trinity Health said it believes "everyone deserves access to high-quality health care."

"That's why we're determined to protect patient access to Trinity Health of New England and push for what's right, so we are here to care for the next generation."

Trinity Health said it is urging its patients to call Aetna or ask their employer to let Aetna know that it is important to protect their access to Trinity Health Of New England and its providers. Patients can find more information and a list of plans that will include Trinity Health Of New England in 2025 by visiting TrinityHealthOfNE.org/Aetna or calling (860) 331-8070.

In addition to St. Francis Hospital, Trinity Health of New England includes Mount Sinai Rehabilitation Hospital, Hartford; Saint Mary's Hospital, Waterbury; Johnson Memorial Hospital, Stafford Springs; and Mercy Medical Center, Springfield.

Kenneth R. Gosselin can be reached at kgosselin@courant.com.

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