A group of Connecticut hospitals has sued Anthem Blue Cross and Blue Shield claiming the insurer is refusing to pay them directly for medically necessary emergency care in retaliation for not signing a new provider agreement.
Anthem told Hartford HealthCare Corp. that it will only pay patients directly. The patients then have to pay the hospital. HHC, which represents six state hospitals, said Anthem changed its payment policy after failing to reach a last-minute agreement on a three-year contract in September. HHC said it rejected Anthem’s last contract offer because it contained “unfairly low reimbursement rates.”
The federal lawsuit filed Thursday in U.S. District Court in Connecticut seeks an injunction forcing Anthem to pay HHC instead.
The lawsuit claims Anthem paid HHC directly for emergency care for decades, and that the new policy puts ”an unfair and substantial burden on both the affected patients and Hartford HealthCare.”
The patient, HHC said, “will have the burden of collecting those checks, cashing them, and making arrangements to pay Hartford HealthCare themselves. This process is time-consuming, and fraught with risk of lost checks, mispayments, and other issues.”
The new policy brings ”significant administrative burdens” for the hospitals, according to the lawsuit. That includes waiting to receive the reimbursement from the patients and follow-up efforts tracking down delayed, misplaced, lost and wrongly cashed checks.
HHC said Anthem hasn’t explained the change in payment policy, and that the insurer’s actions violate state and federal law, and the Patient Protection and Affordable Care Act.
The lawsuit claims the ACA requires Anthem to pay HHC directly for necessary emergency medical services. Connecticut General Statute §38a-477aa(b)(3)(A) requires insurers to pay health care providers directly for emergency services provided out-of-network.
Anthem no longer has a participating provider agreement with HHC, which was forced to become an out-of-network provider, according to the lawsuit.
In addition to the injunction forcing Anthem to pay HHC directly, HHC is seeking a declaration that Anthem’s actions violate the ACA and Connecticut law, and attorney fees.
The involved hospitals are Hartford Hospital, The Hospital of Central Connecticut at New Britain General, Bradley Memorial, Midstate Medical Center, The William Backus Hospital and Windham Community Memorial Hospital.
Sarah Yeager, director of communications for the Wallingford-based Anthem, did not respond to a request for comment Friday.
Roy Breitenbach, an attorney with Garfunkel Wild in Stamford, represents HHC. He also did not respond to a request for comment.