One of the state’s largest health insurers has notified its members that its contract with will terminate April 1 unless a new agreement is reached. But the news comes as a surprise to the hospital head, who says negotiations are ongoing and he’s hopeful a compromise will be reached on financial terms.
“Despite good faith efforts by both parties to negotiate a new contract,” the UnitedHealthCare letter, dated March 1, reads, “we have not yet reached an agreement to extend Middlesex Hospital’s participation in our network.”
“We are still having discussions with them and have been for a number of months,” says Vincent G. Capece Jr., Middlesex Hospital president and CEO. “I am optimistic that we will be able to come to terms at some point — if not by April 1 then some time after that. Time will tell.”
Ben Goldstein, PR Director, UnitedHealthcare, says Oxford HealthCare commercial insurance clients are also affected. Oxford is a product offered by UnitedHealthcare.
"UnitedHealthcare remains in active discussions with Middlesex Hospital and both parties are committed to renewing this contract," Goldstein says. "We hope to have a new agreement in place before the April 1 deadline."
"Based on our own data, approximately 6,000 total UnitedHealthcare members across all these plans have accessed Middlesex’s facilities within the last 12 months," Goldstein says. "Medicare and Medicaid plans are not impacted by this negotiation."
UHC members may have to choose a new hospital or pay non-participating rates, which would be higher. However, the letter states, “emergency services will be covered at network benefit levels regardless of whether you go to a network or non-network hospital.”
"The letters are a regulatory requirement," Goldstein says, not an indication that UHC doesn't believe terms can be reached. "Insurers are required by insurance regulations to notify members within 30 days of a contract's expiration if a new contract has not been signed."
Enrollees are referred to neighboring hospitals, Midstate Medical Center in Meriden; Hospital of Central Connecticut in New Britain and Southington; Yale-New Haven Hospital, Hartford Hospital, St. Francis Hospital & Medical Center in Hartford and UConn Health Center in Farmington; after March 31.
As far as UHC's contract expiration dates with these hospitals, Goldstein says, "UnitedHealthcare's contracts are proprietary so we're not able to release such details."
UHC, with 545,298 enrollees in the state, is the fourth on the list of the 10 biggest health insurers in Connecticut ranked by market share, according to the National Association of Insurance Commissioners in early 2011.
Capece says he understands the insurance company’s contraints. “They’re being pressured from members to keep costs down. There are larger and larger deductibles many of them can’t afford that.”
"Our focus is on offering reasonable rates that will not put an unnecessary cost burden on consumers during these difficult economic times," Goldstein says. "We are also mindful of Middlesex’s need to be competitive with other health systems in the state and have offered rates that we believe will enable them to continue to compete with other facilities."
“Hospitals are an inflationary business,” Capece says. “The cost of providing care continues to go up. It’s a real problem.”
Elevating the quality of care to patients, he says, by employing state-of-the art equipment, research and technology, isn’t cheap.
has been designated four times as one of the Thomson Reuters 100 Top Hospitals and was one of only seven Connecticut hospitals on the HealthGrades list of Safest Hospitals in America. In 2001, Middlesex became Connecticut’s first and only magnet hospital, a nursing excellence award by the American Nurses Credentialing Center, and has retained its designation since then.
“No one else in Connecticut has done that,” Capece says.
“We think in order to continue that [level of care], we need to make a certain amount of money,” Capece says. “This is going on all over Connecticut and the country. It’s not just us. Next week it could be [another healthcare provider negotiating with the hospital].”
With these types of contract disputes, patients, Capece says, “get stuck in the middle. The only thing to do is to switch insurance carriers, but there’s no guarantee [if they do that] in another six months, they won’t be stuck in the middle again.”
Transitional care may be offered to some members or providers who request it from UHC in cases such as low-risk pregnancy, non-surgical cancer treatment, end-stage kidney disease and symptomatic AIDS treatment and others.