ECHN’s Contract With Anthem Set to Expire at End of December

Less than two months after it with UnitedHealthcare/Oxford Health plans, Eastern Connecticut Health Network could be headed for a similar stalemate with another major insurer, Anthem Blue Cross and Blue Shield.

The existing contract between Anthem and ECHN, which manages and hospitals, is slated to expire on Dec. 31. If a new deal were not reached before that date, Anthem customers would face higher, out-of-network rates if they sought coverage at ECHN hospitals.

An Anthem spokesperson said there were approximately 1.45 million Anthem customers in Connecticut. 

Rosemary Martocchio, an ECHN spokesperson, said that the hospital chain was “doing everything we can to avoid any disruption in our patients’ ability to receive care at our two hospitals.”

“At this time, ECHN continues to have productive conversations to renew contracts with several insurance carriers, including Anthem, and we remain focused on coming to agreement as soon as possible for the benefit of our patients and physicians,” Martocchio said. “As a matter of law, Anthem was obligated to give notice to their membership regarding the termination date of our contract with them. We are very grateful to our patients and physicians for their understanding and patience as we work toward coming to agreement with their respective health insurance carriers.”

When its contracted with UnitedHealthcare/Oxford Health plans expired Oct. 15, ECHN said it remained committed to working out a new agreement with the insurance provider, but no deal has been struck.

If ECHN’s contract with Anthem were to expire, customers of the insurer would still be able to use Manchester Memorial and Rockville General hospitals during emergency situations, but regular care or treatment at the facilities would be subject to higher out-of-network costs. The change would not effected Anthem customers who have existing procedures scheduled at ECHN hospitals after Dec. 31, who are currently hospitalized and might still be hospitalized at ECHN facilities beyond Dec. 31, or those in their third trimester of pregnancy, although the insurer asks customers in those situations to contact Anthem to fill out the appropriate transition forms.

If a new agreement with ECHN cannot be reached, it would also apply to affiliated ECHN facilities, such as the Wellness Center in Glastonbury and the Women’s Center for Wellness in South Windsor.

“Anthem Blue Cross and Blue Shield understands how important health care is to our members. We believe our highest priority is managing quality and costs. To do this, Anthem has modified its practice of paying primarily for volume to paying for better outcomes and improved quality and safety, which contribute to reducing overall costs. We are focused on aligning rate increases for providers with programs and measures that demonstrate safety, quality and value,” Sarah Yeager, an Anthem spokesperson, said in a statement Monday. “We continue to negotiate but if we are unable to reach agreement on acceptable renewal terms, then effective Jan. 1, 2012, they will no longer be participating hospitals in Anthem's networks.”