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February 10, 2023

ConnectiCare, ECHN in contract stalemate

Nancy Thompson / Journal Inquirer Manchester Memorial Hospital.

Patients at Rockville General and Manchester Memorial hospitals may be forced to find alternative hospitals and in many cases new doctors and primary care as negotiations between ConnectiCare and Prospect Medical Holdings Inc. have stalled.

ConnectiCare customers received a letter Jan. 26 from Erik Johnson, the insurer’s vice president of network strategy and operation, informing them that beginning March 1 Manchester Memorial, Rockville General, and Waterbury hospitals, along with the associated doctors in the Prospect Professional Provider IPA, would no longer participate in its coverage network.

Between Rockville and Manchester hospitals alone about 6,500 customers will be affected, ConnectiCare spokeswoman Kim Kann said.

“We tried to reach an agreement with the above-listed hospitals and provider group to keep care affordable for you and all our members, but this was not possible,” Johnson wrote in his letter to customers. “This means the health care professionals you have been seeing for treatment at the above-listed hospitals and their associated doctors may no longer be part of ConnectiCare’s networks.”

Therefore, patients who chose to stay with their Prospect ECHN doctors and facilities will wind up paying that entire bill out-of-pocket.

Some patients questioned the timing of the letter, noting that had they known sooner, they could have changed providers and stayed with their doctors. Open enrollment for health care policies ran from Nov. 1 to Jan. 15.

Johnson said patients could still continue seeing their doctor if they are affiliated with another participating hospital or provider group in ConnectiCare’s network.

“Your care is our top priority, and we know your relationship with your health care professional is not only important, but personal,” he wrote. “ConnectiCare is committed to helping you find a new care provider affiliated with an in-network hospital.”

The letter notes that patients of Prospect ECHN will still be able to get funded care at the hospitals mentioned through April 30 and that services will be covered as an in-network hospital during that time.

Some may be eligible for an extension, and pregnant women in their second or third trimester may qualify for a continued care period that extends through the postpartum period.

Nina Kruse, Prospect ECHN spokeswoman, said company officials continue to negotiate with ConnectiCare.

“These discussions are a necessary effort to support dedicated health care providers and ensure patients have access to local health care,” she said.

If no agreement is reached, Kruse said, ECHN’s contract with ConnectiCare will terminate on Feb. 28 and would affect the insurance company’s employer-based, state-based, and Medicare Advantage programs.

ECHN is seeking “fair compensation” from ConnectiCare to cover ECHN’s costs, and “advance our services to benefit patients while sustaining our provision of high-quality, high-value services,” Kruse said. The state allowed health care insurance rates to increase last year, “benefiting ConnectiCare by an average increase of 15%.”

She said some increases ranged between 10% to 23.6%, depending on the type of coverage plan.

“These increases are significantly more than what ECHN is requesting in reimbursements for providing health care,” Kruse said. “ECHN is working hard to reach an agreement before the deadline so there is no disruption to the service and care we provide.”

In a brief statement, Kann said the insurance company “has an obligation to control costs for all its customers,” including employers, those purchasing insurance through the individual market, and those purchasing a Medicare product.

“We are sensitive to the impact that rate increases and out-of-pocket costs have on our members,” she said. “The contracts we have in place directly impact customer costs. We continue to negotiate in good faith with Prospect.”

California-based Prospect Medical is in the process of selling its Connecticut health systems to Yale New Haven Health. It is not yet clear what that would mean for ConnectiCare customers should the $400 million deal be approved, Kann said.

The sale includes Rockville and Manchester hospitals, as well as ECHN health care providers and imaging groups in South Windsor.

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