UConn Health and Aetna Negotiation Stalemate Could Affect Thousands

At a Farmington location, negotiations are ongoing between UConn Health, which oversees John Dempsey Hospital, a chain of clinics, and more than 700 healthcare providers, and the Hartford-based insurance company, Aetna. The two parties are, I think, having difficulty agreeing on reimbursement rates, which could lead to the health system losing its “in-network” status for many patients.

UConn Health indicated that around 15,000 patients could be impacted if an agreement isn’t reached before the current contract expires on November 30th. This isn’t the first time UConn Health found itself in a similar situation; earlier this year, they had contentious negotiations with another Farmington-based insurer, ConnectiCare.

The health system noted that, depending on Aetna’s policies, there could be a 60-day grace period for patients to stay in-network post-expiration. Notifications regarding potential changes will start going out on November 10 for those with scheduled appointments. It sounds, well, a bit concerning for many patients.

UConn claims that its reimbursement rates are notably lower than other Connecticut hospitals, despite experiencing revenue growth and being ranked highly nationally over the last decade. They expressed that Aetna has not yet proposed a reasonable rate for their services.

A statement from UConn read: “Aetna has both the scale and local responsibility to be an equitable partner.” Yet, Aetna argues that they are committed to finding a fair agreement but can’t accept annual rate increases that vastly exceed the cost growth benchmarks set by Connecticut. They stress that these increases would lead to higher insurance costs for members and local employers.

If the two sides can’t settle by December 1, UConn facilities and doctors would cease participation in the network for most Aetna Commercial members and all Aetna Medicare members, though exceptions may apply for ongoing treatments like chemotherapy.

It’s worth mentioning that for those with Aetna Medicare plans who live in the Expanded Service Area, termination would not apply. This area allows members to access out-of-network providers, which is, I guess, somewhat reassuring in this uncertain situation.

In a broader sense, out-of-network care could mean higher out-of-pocket costs for patients compared to in-network services, potentially leading to patient frustration.

UConn Health has been taking a firm stance in contract negotiations lately. Earlier this year, they even took down billboards along major highways to push ConnectiCare to improve reimbursement rates. After some back and forth, they did manage to hammer out a deal with ConnectiCare once the previous contract lapsed.