Insurance company United Healthcare’s contract with hospital chain Hartford HealthCare is set to expire Monday. If the contract expires thousands of people could lose access to their doctors or face high out-of-network costs.
United has more than 600,000 members in Connecticut and offers access to more than 26,000 providers statewide. After United sent notices to members in the HHC network last month, call volumes surged from concerned members to the Office of the Healthcare Advocate, said Kathleen Holt, state health care advocate.
“Consumers are expressing feelings of concern, confusion, and in some cases pure panic,” she said. “Many of the calls to OHA include heartbreaking stories of patients who are scared and feel completely at the mercy of payer versus provider, through no fault of their own and with no control over the outcome.”
Kristen Whitney Daniels, 34, is being treated for post concussion syndrome at HHC’s Headache Center after a car accident last July. Part of her treatment includes an injection administered every three months, she said.
“As luck would have it, April 2 is when I'm due for my next injection. I have no idea if I'm going to be able to receive my treatment,” she said. “I have no idea if I'm going to be able to see my neurologist. I can't be scheduled for certain appointments right now because we don't know if I'll have any sort of coverage.”
She said her care team is equally concerned.
“I have been talking to my neurologist there, and they're all just as upset as we are at the thought of losing this continuity of care,” she said. “And while United Healthcare has sent out this letter that we can apply for continuity of care, the terms are so limited.”
Compounding her woes, Whitney Daniels, who is a member of the Connecticut Citizen Action Group, said her out-of-pocket deductible recently rose to $10,000, making it impossible for her to access out-of-network providers.
Conditions that do not qualify for transition of care and continuity of care include diabetes, arthritis, allergies, asthma, kidney disease and hypertension. Also routine exams, vaccinations, health assessments, colds, sore throats, ear infections and elective surgeries.
Whitney Daniels said the exclusion of diabetes and hypertension, for example, was of grave concern as “all these diseases require you to have a relationship with your doctor.”
What the companies are saying
The $400-billion United said HHC is seeking higher prices for United’s commercial insurance plans and higher reimbursements for United’s Medicare Advantage network in Connecticut.
“Altogether, HHC’s proposal would increase health care costs by nearly $200 million for consumers and employers. It remains our top priority to reach an agreement but we need HHC to approach the negotiation with a realistic proposal Connecticut families can afford,” a United spokesperson said in a statement.
A HHC spokesperson said that the health organization was “very aware of the impact negotiations have on the communities and patients we serve. We are working diligently to resolve remaining issues to ensure a mutually agreeable contract and believe we can reach a resolution soon.”
According to a statement from HHC, “We have responded to United’s proposals on average in eight days, whereas United has taken an average 30 days to respond. We believe a fair agreement is achievable with United’s cooperation.”
The statement continued, “United is offering our hospitals and physicians rates that simply do not cover our cost increases, including salaries and benefits, medical supplies, drugs and vendor services. United’s offer will negatively impact our ability to retain and recruit clinical staff in our care settings.”
According to United, more than 65% of HHC’s proposed price hikes for United’s commercial plans would be paid out of the operating budgets of self-insured employers.
The majority of United’s commercial members in Connecticut are enrolled in self-insured plans and directly pay for medical costs incurred by employees and their dependents. United provides a variety of services to these employers including negotiating favorable discounts from providers like HHC.
United said if it were to agree to HHC’s current proposal, nine of United’s self-funded businesses would see their health care costs go up by at least $500,000 or more, while some of the most heavily impacted employers would see their costs increase between $1.3 million to as much as $6.3 million.
United said HHC’s physician costs are also a significant outlier compared to the rest of the state, with rates approximately 20% higher than the average cost of all other physicians in United’s network in Connecticut.
Patients caught in the middle
As the back-and-forth plays out between insurance companies and health care providers, patients like Tim Appleton, a member of Citizen Action Group, said they feel like a “pawn" caught between mega corporations.
In his case, he said he was caught in uncertainty during contract disputes between HHC and Cigna, later resolved.
“I was under threat of my cancer treatments and care being taken away from me two-thirds of the way through recovering from colorectal cancer,” he said. “It affects not only your physical health, but your mental health as well.”
Advocates said contract disputes like the one between United and HHC are prioritizing profits over patients — and are calling for lawmakers to intervene.
“We do hope that in Connecticut the legislature has actions they can take to attack the structural causes of this," said Liz Dupont-Diehl, associate director of the Connecticut Citizen Action Group. "What's happening with Hartford HealthCare and United is a symptom of a much larger problem.”
Learn more
In response to the need for guidance amid the continued uncertainty, the Connecticut Office of the Healthcare Advocate has created a set of frequently asked questions to help Connecticut residents impacted by the dispute.
