A major dispute between Connecticut’s health system and a leading insurer has put up to 15,000 patients at risk of higher out-of-pocket costs as their contract nears expiration. One week after UConn Health’s agreement with a top insurer lapsed, both sides are standing firm in negotiations, each accusing the other of not presenting a fair proposal.
UConn Health, based in Farmington and owned by the University of Connecticut, and Aetna, the Hartford-based insurer owned by CVS Health, say they hope to extend the contract. However, neither side has backed down from claims that the other is seeking unreasonable terms.
If no new deal is reached, most patients with Aetna coverage who seek care at UConn Health’s hospital, clinics, and affiliated providers would lose in-network status, potentially facing higher costs.
Central to the talks are the reimbursement rates Aetna pays to UConn Health for services. UConn Health oversees John Dempsey Hospital, a network of clinics, and more than 700 providers.
Aetna contends that UConn Health is asking for substantially higher reimbursement rates, which would raise healthcare costs for Connecticut families, workers, and retirees. The insurer says it has made good-faith efforts toward a fair agreement and remains ready for constructive discussions, awaiting a reasonable proposal from UConn Health.
UConn Health counters that Aetna’s offered terms do not adequately cover the costs of delivering top-tier care and notes disappointment that a resolution hasn’t been reached. The health system argues that Aetna’s current reimbursement rates are markedly lower than those offered to other state health systems, an imbalance deemed unsustainable for Connecticut’s sole public academic medical center that provides high-quality care.
Industry observers note that out-of-network care can carry substantial financial risk for patients. Depending on the plan, out-of-network services may not be covered or may incur significantly higher out-of-pocket costs. Federal protections on out-of-pocket limits typically apply only to in-network care, and balance billing by providers is a possibility when patients receive care outside their insurer’s network.
For patients who are out-of-network, finding in-network providers can become necessary. Connecticut retirees and certain Aetna Medicare Advantage Extended Service Area members are not subject to termination under the current discussions. Those who are actively undergoing treatment or facing scheduled procedures may continue at in-network rates for up to 90 days, and emergency care remains covered at in-network rates, according to UConn Health.
In recent months, UConn Health has demonstrated a willingness to leverage public pressure in contract talks. Earlier this year, the system ran billboard campaigns along major highways to press another insurer, ConnectiCare (now part of Molina Healthcare), to raise its rates. A new agreement was later reached with ConnectiCare after its contract expired.
For further details, contact Kenneth R. Gosselin of Courant.
But here’s where it gets controversial: both sides claim the other is protecting profits over patients’ access to affordable care. And this is the part many observers miss: the outcome could set a precedent for how public academic medical centers negotiate with large insurers across the state. What stance should Connecticut take to balance the costs and ensure continued access to high-quality care across public institutions? Share your thoughts in the comments.
