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October 10, 2017

HHC sues Anthem over emergency reimbursement procedures

PHOTO | HBJ File The front entrance to Hartford Hospital, Hartford HealthCare's flagship campus.

Hartford HealthCare is suing insurer Anthem for refusing to reimburse the healthcare provider directly for emergency medical services, alleging Anthem is retaliating because HHC didn’t renew its contract.

The two parties are in the midst of protracted negotiations following the expiration of their contract on Sept. 30.

Hartford HealthCare filed its suit Oct. 5 in U.S. District Court of Connecticut, alleging that Anthem is violating the Affordable Care Act and state statute by no longer treating Hartford HealthCare as a network provider, and reimbursing HHC directly for medically necessary emergency care. Instead, Anthem is putting the burden on patients to seek reimbursement for covered emergency medical expenses, HHC says.

Patients receiving medically necessary emergency care are being paid directly by Anthem instead of through HHC, the lawsuit states.

Up until the contract expired, Anthem had reimbursed HHC directly for care that HHC provided to Anthem clients. And HHC had a long history of being treated as a network provider, though with the expiration of the contract, it is effectively an “out-of-network” provider, according to the lawsuit.

"Because of [Anthem's] steadfast refusal to renew the participating provider agreement unless and until Hartford HealthCare agrees to unfairly -- and catastrophically -- low reimbursement rates, Hartford HealthCare was reluctantly forced to become an out-of-network provider" for Anthem, effective Oct. 1, the lawsuit states.

HHC maintains that the lack of a contract means Anthem customers, which number in the tens of thousands, will have to pay higher out-of-pocket costs if they go see a Hartford HealthCare provider.

HHC is seeking a permanent injunction that would require Anthem to pay HHC directly for medically necessary care.

“The action seeks to stop Anthem from putting patients who seek emergency care in the middle of the payment process, thus burdening and confusing these patients,” HHC said in a statement.

Anthem has said it wants HHC to agree to cost-of-living increases that are "comparable to increases accepted by other hospitals in the state.” The rate increase HHC is seeking is up to three times the rate of inflation, an increase Anthem calls unacceptable.

Both parties said they are still in talks to revive the expired contract, but Anthem Spokesperson Sarah Yeager declined comment on the pending lawsuit.

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