Martin M. Looney

Senate President Pro Tempore

Martin M. Looney

An Advocate for Us

November 28, 2017

Senate President Pro Tempore Looney: Contract Disputes Between Hospitals & Insurers Put Patient Care at Risk

Sen. Looney: Hospitals and the insurers have engaged in brinksmanship with a seeming disregard for the wellbeing of the patients

Senate President Pro Tempore Martin M. Looney (D-New Haven) today testified before to the Insurance and Real Estate Committee pledging to introduce legislation in the 2018 session to protect health care consumers from losing network coverage during contract disputes between health systems and insurers.

Earlier this month, Hartford Healthcare and Anthem Blue Cross and Blue Shield announced an agreement ending a seven-week impasse that left tens of thousands of patients in Connecticut with limited options and access to treatment and skyrocketing costs.

“There have been numerous situations over the last few years in which contract disputes between hospitals and insurers put patient care at risk,” testified Senator Looney. “Both the hospitals and the insurers have engaged in brinksmanship with a seeming disregard for the wellbeing of the patients. This is an unacceptable situation for patients.”

Senator Looney continued, “This brinksmanship puts patient health at risk and exposes the fact that some sectors of our healthcare system put profits ahead of patients. The people of Connecticut deserve better.”

Senator Looney originally introduced legislation in 2015 requiring binding arbitration to resolve disputes between hospitals and insurers when the parties fail to reach an agreement.

Senator Looney testified that legislation addressing the issue should include the following elements:

  • Require that the parties continue negotiating for a specified time and allow either party to request binding arbitration.
  • Require that physicians cannot become out of network during the patient’s policy term. If a patient selects a plan that has the patient’s desired physician in-network, that physician shall not become out of network during the term of the policy.
  • Require that during the time that the parties are negotiating after the insurer and the provider are no longer under contract with each other, the patient shall be held harmless and shall not have to pay more than the in-network cost sharing. The provider and the insurer shall either: 1. follow the reimbursement mechanism set up for out of network emergency services—the patient is held harmless and the provider is reimbursed at the greatest of the in-network rate, the Medicare rate, or 80 percent of the Usual and Customary rate—and the provider shall bill the insurer directly or 2. Continue under the terms of the expired contract until the dispute is resolved.
  • Require that the terms of these agreements be made available to the insureds.
  • During these insurer versus provider contract disputes allow policy holders to select a new policy without penalty even if this is occurring mid-year of the policy outside the normal enrollment period.