Insurance Payment Dispute Threatens Patient Care

Connecticut Children's Medical Center and Anthem Blue Cross Blue Shield remain in contract dispute as the deadline approaches.

Thousands of families that rely on the Connecticut Children's Medical Center in Hartford could soon be faced with a tough choice: to either go elsewhere for their care or pay high out-of-network rates.

That's because the hospital and Anthem Blue Cross Blue Shield have so far failed to reach a new contract for reimbursement rates. The deadline is Sunday and if no deal is reached the hospital will no longer accept Anthem insurance at lower in-network rates.

Tinisha Brooks of Vernon is among the parents who are concerned. She has Anthem insurance and brings her four-year-old son to Connecticut Children's to see a specialist.

"If he doesn't have the insurance how's he going to get his medicine? I don't work over minimum wage as of now so that's not fair to people that don't have nothing," Brooks said.

Connecticut Children's released a statement that said current reimbursement rates fall well below the national average for children's hospitals. In the statement, hospital president Martin Gavin said,

"To be able to maintain our ability to offer children and families the care they deserve, we must stand firm on the principle that insurance companies compensate us fairly. Doing so is a critical step we need to continue to provide the highest quality and safest care to our patients and their families," hospital president Martin Gavin said.

"Anthem's current contract more than covers the hospital's costs for rendering services to our members, and allows the hospital to earn a significant profit on Anthem's business," the insurance company said in a statement.

The insurer also said it is offering to increase current rates by an unspecified amount, but that Connecticut Children's continues "to look for commercial insurance carriers to absorb and cover increasingly greater amounts of the shortfalls from government payments."

If no deal is reached, the impact will stretch beyond Connecticut Children's.

Anthem said care at the UConn Health Center Neonatal Intensive Care Unit in Farmington would also be affected. So would all inpatient pediatric care at St. Mary's Hospital in Waterbury, except for that hospital's NICU. Both programs are operated by Connecticut Children's, according to Anthem.

For now, families that will be affected by the insurance payment dispute wait and hope a deal is reached.

"Pretty much it would have to come out of pocket if they switch it. We have no choice I guess, but I hope they don't do that," said Brooks.

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