Bill regulating insurer-hospital disputes advances

PHOTO | Gale Development An aerial view of health insurer Anthem's Wallingford campus.

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By Matt Pilon

House lawmakers voted unanimously Wednesday afternoon on a bill that seeks to further protect patients in the event of a contract fight between their insurer and care provider.

The House approved the bill on a bipartisan basis by a 147-0-3 vote around 1:30 p.m. Wednesday.

The legislation requires hospitals and insurers to notify each other 90 days in advance of either deciding to end a network contractual arrangement, up from the current 60-day requirement. The parties would also have to continue to abide by the contract’s reimbursement terms for 60 days after the non-renewal or termination.

Unless both sides agree otherwise, the terms of any new contract reached would be retroactive to the end of the prior agreement.

Both sides would still be required to make a good faith effort to notify all impacted patients in advance of a contract’s termination.

Both Senate President Pro Tem Martin Looney (D-New Haven) and Senate Republican President Len Fasano (R-North Haven) have pushed to change contract-dispute rules, though the current version of the bill falls short of Looney's recent push for changes to arbitration rules.

Both said in written testimony that legislative action is needed because of recent notable hospital-insurer disputes, such as one last year between Anthem and Hartford HealthCare, which was resolved nearly seven weeks after their contract expired.

Fasano said those situations caused “tremendous anxiety” and uncertainty for patients, particularly for those who need ongoing care, such as pregnant women and those with chronic conditions.

Looney, who has proposed similar measures for the past several years, believes such disputes amount to “brinkmanship with a seeming disregard for the wellbeing of patients.”

Hospitals and insurers have both pushed back against similar assertions.

“Hospitals’ paramount concern is to ensure that during these negotiations, patient care is not disrupted and patients are able to receive the care they need,” the Connecticut Hospital Association said in written testimony on the bill. “Negotiations about health insurance are always challenging, as hospitals are focused on the need to be compensated appropriately for the care they provide, and health plans are focused on the cost of premiums. In recent years, the negotiations have become even more challenging as reimbursements in the Medicare and Medicaid program have decreased.”

Meanwhile, health plans say that the negotiation process is important for consumers.

“...tough negotiations by health plans are often in the best interest of consumers as there are times when pressure must be applied to provider reimbursement schedules in order to keep premiums affordable,” the Connecticut Association of Health Plans testified.

The Senate has not yet voted on the legislation.