Across Connecticut, patients say they’re getting caught up in the ongoing contract standoff between Anthem Blue Cross Blue Shield and Hartford HealthCare, many of them postponing treatments or being hit with unexpected bills.
As the corporate financial dispute continues into its second month, most people say they’re scrambling to find new doctors or signing up for non-Anthem health insurance plans during open enrollment. But those who need health insurance the most, patients with frequent or chronic health issues, are having a harder time. They’ve had to put off much-needed surgeries and ration pills and doctor’s visits, and also risk higher costs to see the now-out-of-network doctors they trust.
“There are so many people that are being put in a really precarious position because they can’t go to their normal doctors,” said Bonnie Fineman of Windsor, who has three doctors — a neurologist, a dermatologist and a surgeon — who are no longer part of Anthem’s network.
From Hartford to Windham to New London, Anthem customers have been weighing their health-care options since Sept. 30, when Anthem’s contract with Hartford HealthCare expired and the extensive network of hospitals and providers — including Hartford Hospital, Backus Hospital in Norwich, Windham Hospital, MidState Medical Center in Meriden and the Hospital of Central Connecticut in New Britain and Southington — started billing at higher, out-of-network rates.
Anthem has said only that it is continuing negotiations, while Hartford HealthCare has said the two do not appear to be close to a resolution.
On Friday, the network added, “We are deeply concerned about the disruption this is causing our patients, but Hartford HealthCare needs a fair agreement with Anthem so we can continue to provide patients access to the high quality and coordinated health care they deserve.”
Anthem says Hartford HealthCare is simply asking for too much money. “If HHC gets the price hikes it has demandetd, by 2020 it will have cumulatively received a jump in fees of over 90 percent relative to prices in 2010,” the insurer said.
Hartford HealthCare has rejected multiple offers to continue working with Anthem under the old contract while negotiations are ongoing, Anthem said, which would allow patients to continue to receive in-network rates.
On Thursday, Connecticut Comptroller Kevin Lembo called the dispute an “outrageous failure” to protect the welfare of patients.
Consumers can apply through Anthem for continuation-of-care benefits, which are intended to allow patients to keep seeing their Hartford HealthCare doctors and pay the cheaper, in-network rate in certain cases, including if they are in the middle of treatment for a chronic condition or in their second or third trimester of pregnancy.
But one woman who applied for those benefits still wound up with a $4,700 bill.
Cheryl Powers, a 54-year-old Department of Developmental Services employee who has a rare blood cancer, gets a colonoscopy every two years to screen for colon cancer. She requested continuance of care and kept the appointment, even though she hadn’t gotten a formal letter back.
“[An Anthem representative] told me, ‘Go and have the procedure and don’t worry,'” Powers said. “Now I have an over $4,000 bill and I don’t know how I’m going to pay it.”
Rationing Treatment, Postponing Care
Some patients said last week that they are simply putting off procedures, often growing sicker in the process.
Deanna Boast, a longtime Connecticut resident before she moved to Rhode Island, is putting off much needed back surgery for spinal stenosis because her surgeon operates only at Hartford Hospital. Twice since Oct. 1, flare-ups have forced her to visit the ER to get shots of cortisol, and most days the pain prevents her from standing for too long.
“I’ve gained 30 pounds because I can’t walk anymore. It’s just gotten really bad,” she said.
Boast is also trying to ration out the three primary care visits with her Coventry physician that Anthem agreed to cover as a continuance of care — three visits that could easily be whittled away by checkups for her diabetes, high blood pressure and chronic obstructive pulmonary disease.
After 35 years with the same physician, 54-year-old Boast said she’s angry that she may have to find someone new.
“That bothers me the most,” she said. “It’s hard for me to trust anybody and I don’t know what I’m going to do for a doctor.”
In Mansfield, Sandy Nadeau is delaying an arthritis surgery at an outpatient center in Glastonbury operated by Hartford HealthCare.
“He’s operated on both hands, at least three operations,” she said about her surgeon. “I have confidence with him. I come out of it really doing well. I want go back, but I don’t want to pay an exorbitant amount of money.”
Simsbury resident Mark Riley has to have surgery every 90 days to put a stent in his pancreas to treat chronic pancreatitis. His procedure last week at Hartford Hospital was canceled due to the contract dispute.
Riley is applying for continuation-of-care benefits but he said it hasn’t been an easy process.
It’s not as simple as going to another gastrointestinal specialist or replacing the Hartford Hospital surgeon who knows his pancreas inside and out.
“He’s been in there 20 times,” Riley said.
If the continuation of care is approved, it could still be another six to eight weeks before Riley can book another surgery, he said.
Others have tried to move on and work within Anthem’s network only to find more problems and delays.
Debbie Ahl, a state employee who lives in Bristol, found a new doctor but couldn’t get an appointment until February.
So she’ll try to stretch out her blood pressure and diabetes medication until then.
“I’ll have to skip some doses or something to make sure I get to Feb. 9 when I can see this other doctor,” she said.
Powers, of Norwich, had to get an ultrasound to check out a mass on her kidney. After getting the bill for her colonoscopy at Hartford Hospital, she decided to visit Lawrence and Memorial Hospital in New London, which is in-network for Anthem.
Powers says she still got a small, unexplained charge of $50.
Anthem has since agreed to pay the unexplained charge, but Powers says the insurance company has lost her trust.
“It’s supposed to be paid 100 percent,” she said. “I’m a state employee and we gave and we gave and nothing was supposed to change like this. It’s an argument between an insurance company and Hartford Healthcare and it shouldn’t have anything to do with patients.”
Nadeau, from Mansfield, echoed that common complaint: Patients are paying their premiums, but their coverage has been severely restricted.
“We pay our premiums and they turned around and limited us to a smaller group [of doctors] and that’s not fair,” she said.
An Added Aggravation
Tens of thousands of people with Anthem insurance typically visit Hartford HealthCare facilities.
But since Oct. 1, patients have been warned that they will be billed at higher, out-of-network rates by Hartford Hospital, Backus Hospital in Norwich, Windham Hospital, MidState Medical Center in Meriden and the Hospital of Central Connecticut in New Britain and Southington, and other doctors associated with Hartford HealthCare.
For many people, the sudden network change has grated on nerves already shot by ongoing health issues.
Lisa Kasprzyk got a phone call the afternoon before a gastrointestinal surgery scheduled for Oct. 4 at Hospital of Central Connecticut and learned her insurance wouldn’t cover the procedure.
Kasprzyk, who lives in Berlin and works at Newington High School, was able to have her surgery shifted to St. Francis Hospital and Medical Center in Hartford with the same surgeon and on the same day, but it was a stressful few hours.
“I’m familiar with the Hospital of Central Connecticut, I know people that work there, my daughter works there, I was there for [an earlier gastrointestinal surgery],” she said. “I had the necessary surgery that I needed but it was in an unfamiliar place.”
Bonnie Fineman of Windsor, who has three doctors — a neurologist, a dermatologist and a surgeon — that are no longer part of Anthem’s network.
“There are so many people that are being put in a really precarious position because they can’t go to their normal doctors,” said.
A Problem for Eastern Connecticut
Aside from Hartford, New London and Windham counties have been hit particularly hard by the impasse. Two of their major hospitals — Backus and Windham — are part of the Hartford HealthCare network and major employers in the region, including Mohegan Sun, UConn, Eastern Connecticut State University and the state government, offer Anthem coverage.
Heather Festa, a Mohegan Sun cashier, and her 5-year-old son, Michael, are in and out of Backus Hospital in Norwich and Connecticut Children’s Medical Center in Hartford every month for regular treatment of Festa’s immune deficiency and her son’s severe asthma.
Both have had emergencies over the past month, and while those extended stays are covered by Anthem, the streak of bad health has kept Festa from filling out her requests for continuance of care.
In fact, since Oct. 1, the 37-year-old Norwich woman has only gone to work once. That means less money is coming into her household as she waits to see what Hartford HealthCare will bill for her monthly antibody infusions and her son’s monthly pulmonologist visit.
“It’s scary (thinking of) going into paralyzing debt just because all of a sudden these two companies can’t reach an agreement,” she said. “I don’t care who’s not budging. I care that people’s lives are at risk here.”
November appointments for her and Michael are coming up but she doesn’t want to put them off — risking more emergency room visits — or find new doctors who are unfamiliar with her and Michael’s extensive histories.
“I’m not playing with our lives,” she said. “We pay premiums for our health care and we should be able to see the doctors we’ve been seeing for some 20-years, not having to go through the rigmarole of trying to explain our problems to another doctor, another hospital.”
Stephanie Bruneau of Colchester was diagnosed with a brain tumor on Sept. 30 after a fall sent her to Backus Hospital. She woke up in the hospital the next day and was told by staff that her insurance wouldn’t be accepted.
All of her treatment since the diagnosis has been through Yale-New Haven Hospital and its affiliates, but Bruneau can’t meet with her primary care physician, who is part of Hartford HealthCare. She’s hesitant to find someone new.
“I want my [doctor],” said Bruneau. “Who’s going to pick up the pieces … and take a 61-year-old women with illnesses? I’m not an easy patient to pick up.”
Victor Funderburk, the newly elected Democratic mayor of Windham, twice had to postpone his annual physical, but he considers himself lucky.
People much sicker than him “are literally not going to their doctor … with some severe consequences,” Funderburk said.
It doesn’t seem fair, the retired teacher added.
“We’re paying for insurance every month and essentially we’re not being provided with the service we’re paying for.”
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