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Anthem and Hartford Healthcare Negotiations

10/2/2017 - Anthem – Hartford Healthcare Update

Good Afternoon,

As you may already be aware, an agreement with Hartford Healthcare was not reached before the termination effective date of October 1. Unfortunately, they were not willing to accept any extension offers to allow more time for working through the negotiations.   As of now, Hartford Healthcare and all of their affiliates are Out of Network for Anthem members. That said, there are a few VERY important things to know:

Anthem is still very much interested in coming to an agreement and is continuing to work with Hartford Healthcare to that end.

We are very focused on ensuring the transition of care process for those currently having or scheduled to receive services. A link to the Continuation of care form is included on the attached.

 Any members that were inpatient prior to October 1 will remain and be covered as in-network until their discharge date.

In emergency situations ANY hospital will be treated as In Network, this includes all those in the Hartford Healthcare system.

Once an agreement is reached, it will be retroactive to October 1. Any claims incurred will be processed as such.

I have attached a Frequently asked Questions document and some alternative provider options.

Please let me know If you have any questions and we will certainly communicate as soon as any new information becomes available.

Thank you!

Carole Lombard
Benefits Coordinator
860-622-5127

Anthem and Hartford Health Care

In late August Anthem notified us that their contract with Hartford Healthcare was scheduled to expire at midnight on September 30, 2017 if an agreement was not negotiated by that date.  To date Anthem and Hartford Healthcare have not reached an agreement.  Therefore, on Sunday, October 1, 2017 hospitals, facilities and providers in the Hartford Healthcare network will change from participating (in-network) providers to non-participating (out-of-network) providers.  We are sending this notice as a reminder of how you may be affected.

What does this mean for me?

If a contract is not negotiated by the September 30, 2017 deadline, effective October 1, 2017 any provider who bills under Hartford Healthcare will be out of network.  This includes all hospitals, doctor offices, laboratory services, visiting nurses, etc., not just Hartford Hospital. 

If you are not sure if your doctor is part of Hartford Healthcare, you should contact your provider or Anthem’s Member Services Department at 888-224-4896.  Additionally, Hartford Healthcare has established a dedicated, toll-free information line – 800-644-5905 - for patients who have questions about how these negotiations could affect access to care. 

Do I have to change doctors?

You can continue to treat with providers in the Hartford Healthcare network; however, you will have to pay higher out-of-pocket costs than you would pay for treating in-network.  For information concerning out-of-network benefits see the Lumenos HSA* fact sheets that are posted on the district’s website www.easthartford.org → Human Resources:Staff Resources → Benefits Information.

If you or a covered dependent is receiving prenatal care or is in active treatment for an acute or chronic condition with a Hartford Healthcare provider you can complete and submit the attached Continuation of Care Form for approval of continuity of care.  Anthem will determine whether the patient can continue to receive care with the out-of-network provider, on an in-network basis, for a designated period of time.  Hartford Healthcare will accept the former negotiated rate with Anthem as payment for services approved by Anthem.

What do I do in an emergency?

Call 911 and go to the nearest emergency room, whether it’s in-network or out-of-network, anytime you have a life-threatening emergency and all services will be covered.

See the August 30, 2017 letter from Anthem and a partial list of participating providers that are available to meet your needs. 

Please visit www.anthem.com or https://hartfordhealthcare.org for more information. 

We will continue to monitor this situation and provide updates as we receive them.  

Hospital Term HHC Alternative Providers Facilities

Questions and Answers for Members and Employer Groups

Q1. What are the hospitals, facilities and providers affected?

A1. The primary locations are at the following addresses:

  • Hartford Hospital: 80 Seymour Street, Hartford, CT
  • MidState Medical Center: 435 Lewis Avenue, Meriden, CT
  • The Hospital of Central Connecticut: 100 Grand Street, New Britain, CT
  • William W. Backus Hospital: 326 Washington Street, Norwich, CT
  • Windham Community Memorial Hospital: 112 Mansfield Avenue, Willimantic, CT
  • Natchaug Hospital: 189 Storrs Road, Mansfield Center, CT
  • Rushford Center: 1250 Silver Street, Middletown, CT
  • Southington Care Center: 45 Meriden Avenue, Southington, CT
  • Jerome Home: 975 Corbin Avenue, New Britain, CT
  • Jefferson House: 1 John H. Stewart Drive, Newington, CT 06111
  • VNA HealthCare: 1290 Silas Deane HWY, Wethersfield, CT
  • Harford HealthCare Medical Group: (various locations)

Q2. Why are these hospitals, facilities and providers no longer in Anthem’s network?

A2. We have been trying to reach agreement on terms for new contracts. These contract negotiations are a standard part of what we do but to date, we have not yet reached agreement. As a result, the contracts ended on September 30, 2017.

Q3. What will this mean if I need services from any of these hospitals, facilities or providers?

A3. As of October 1, 2017, they will be non-participating in Anthem’s networks. If you have out-of-network benefits, services provided are subject to those benefits (except in cases of emergency.) Your out-of-pocket costs will most likely be higher.

Q4. Will Anthem send claim payments to the hospitals/facilities/providers for services I receive?

A4. Anthem will make any payment directly to you. You will be responsible for paying your bill in full.

Q5. I have an HMO plan. How will this affect me?

A5. If you have an HMO plan, you will have to pay all costs for any non-emergency care that you get from any of these hospitals, facilities or providers. As of October 1, 2017, they will all be out-of-network and your plan does not include coverage for any out-of-network hospitals, facilities or providers, except in an emergency.

Q6. I have a POS/PPO plan. How will this affect me?

A6. If you have a POS or PPO plan, you can use a hospital, facility or provider who/that is out-of-network but it may cost you more than using one who/that is in-network. You can still use one of them but the costs, and “who pays what,” will be based on the way your plan pays for services provided out-of- network.  (See your Summary Plan Description for details.)

It is important to remember that using hospitals, facilities and providers who/that are in our network(s) saves you the most money.

Q7. I have a Health Reimbursement Account (HRA) or a Health Savings Account (HSA). How will this affect me?

A7. If you have a plan with an HRA or HSA, you can use a hospital, facility or provider who/that is out-of-network but it may cost you more than using one who/that is in-network. You can still use one of them but the costs, and “who pays what,” will be based on the way your plan pays for services provided out-of-network costs, and “who pays what,” will be based on the way your plan pays for services provided out-of-network.

(See your Summary Plan Description for details.)

It is important to remember that using hospitals, facilities and providers who/that are in our network(s) saves you the most money.

Q8. What if I am not sure what type of plan I have?

A8. If you need help understanding what type of plan you have, you may call the phone number on the back of your Member ID Card.

Q9. When will the hospitals, facilities and providers become out-of-network?

A9. If we are unable to reach agreement, they will change from in-network to out-of-network as of October 1, 2017.

Q10. If I have services or a procedure scheduled at/with one of the hospitals, facilities or providers, do I have to change?

A10. Not necessarily, but here’s what you should do:

  • Get a “Continuation of Care Form” from Anthem.
  • You can get the form on our website, http://group.anthem.com/HHC, or you can call Member Services at the phone number on the back of your ID card and they will email or mail you a copy of the form.
  • Fill out the form and send it to Anthem.
  • We will review it and determine if you can continue with the hospital and still be covered on an in-network basis or if you have to change hospitals to be covered on an in-network basis.
  • If you have to change hospitals in order to get in-network coverage, we’ll help you find a hospital that fits your needs.
  •  

Q11. If I am hospitalized at/with one of these hospitals before October 1, 2017 and am discharged on or after this date, will my admission/services be covered as in-network?

A11. Yes. All of the services you receive until discharge from the hospital will be paid in accordance with in-network benefits.

Q12. If I have surgery at/with one of these hospitals prior to October 1, 2017, can I have my postsurgical follow-up there?

A12. Yes. Your routine post-surgical follow-up will be covered as in-network, provided that the surgery occurs before October 1, 2017.

 

Q13. I am in the third trimester of my pregnancy (28 to 40 weeks). Do I need to change hospitals in order to get in-network coverage when I deliver my baby after September 30, 2017?

A13. No, you do not have to switch right now but here’s what you should do:

  • Get a “Continuation of Care Form” from Anthem.
  • You can get the form on our website, http://group.anthem.com/HHC or you can call
  • Member Services at the phone number on the back of your ID card and they will email or mail you a copy of the form.
  • Fill out the form and send it to Anthem.
  • We will review it and determine if you can continue with the hospital, facility or provider and still be covered on an in-network basis, or if you have to change to be covered on an in-network basis.
  • If you have to change in order to get in-network coverage, we’ll help you find a hospital that fits your needs.
  •  

Q14. What if I have an emergency medical issue?

A14. In an emergency, you should always go to the nearest emergency room, whether it’s in-network or out-of-network. For emergency care, all services at/by the hospital, facility or provider will be covered as though they are in-network. Emergency care means services performed in the Emergency Department or admissions from the Emergency Department as described in the member’s plan documents. An

emergency is any situation or condition, such as the onset of a serious illness or injury that you reasonably believe requires emergency care.

Q15. How do I check on the status of a Continuation of Care Form that I submitted?

A15. You can call the Customer Service phone number on the back of your Member ID Card and we will advise you of its status. You have until October 31, 2017 to submit the form to Anthem. If approved, you will receive notice as to how long you may continue to use the hospital, facility or provider on an in-network basis, which may be up to ninety (90) days after your notification.

Q16. Will the hospitals, facilities and providers ever rejoin Anthem’s networks?

A16. Anthem continues to work with Hartford HealthCare Corporation with the goal of reaching agreement prior to the expiration/termination date.

Q17. I have a Medicare Supplemental/Medigap plan. How will this affect me?

A17. These plans are not limited to any Anthem network. You can go to any hospital, facility or provider that/who accepts traditional Medicare.

Q18. Does this impact Hartford Healthcare Eye Surgery Center?

A18. Yes, Hartford Healthcare Eye Surgery Center is part of Hartford Hospital and will change from in-network to out-of-network as of October 1, 2017. The surgery center is located at 505 Willard Avenue, Newington, CT 06111

Continuation of Care Form

  • Hartford Courant Top Work Places 2011 Award Ribbon
  • Hartford Courant Top Work Places 2012 Award Ribbon
  • Hartford Courant Top Work Places 2013 Award Ribbon
  • Hartford Courant Top Work Places 2016 Award Ribbon
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