Anthem will reprocess claims made before contract reached

But some patients have already moved on

Anthem Blue Cross- Blue Shield will reprocess any medical care claims made by its customers at Hartford Health Care facilities during the nearly two-month period the two companies did not have a contract to cover patients there.

The two companies came to an agreement Saturday on a three- year contract for Anthem to insure patients at hospitals and medical facilities owned by Hartford Health Care after negotiations spilled past the Oct. 1 expiration of their previous contract.

“Anthem is now automatically reprocessing all the claims back to October 1 at the in-network rate,” state Insurance Commissioner Katharine L. Wade said in an emailed statement.

The new three-year contract is retroactive to Oct. 1, so Anthem members who sought health care services since then will receive coverage for those services as if Hartford HealthCare had remained in the Anthem network all along, according to news releases from both companies.

An Anthem spokesperson, though, did not respond Monday to a question about whether and when its customers would be reimbursed if they paid the out-of-network fees for medical care during that period.

Wade added that Anthem policy holders should contact Anthem for the status of their claim, and contact the Insurance Department by calling (860) 297-3900 or by emailing insurance@ct.gov if they have concerns.

The impasse that ended Saturday meant that starting on Oct. 1, people covered with Anthem insurance were charged higher, out-of-network fees to get medical care at any Hartford Health Care facility.

Hartford Health Care is the parent company for The William W. Backus Hospital in Norwich, as well as several affiliated medical practices in southeastern Connecticut.

For Kaire Russell- Nickerson, the wait was too long. The Montville resident said she canceled appointments with her Hartford Heath Care primary care doctor and gynecologist that were scheduled this month because she knew her Anthem insurance policy wouldn’t cover them while the dispute was ongoing.

Then last week, days before the companies finally reached an agreement, she lost patience and switched her health insurance to ConnectiCare, the other provider participating in the Access Health CT exchange in addition to Anthem.

“It went on way too long,” Russell-Nickerson said. “It became, do I switch my insurance company or do I switch every doctor I’ve had for decades?”

Russell-Nickerson said she will now spend about $ 20 more per month for her ConnectiCare plan.

Spokesmen for Hartford Health Care, Anthem and Access Health CT said they had no data about how many people may have switched to a different insurance provider or to a new doctor because of the lengthy contract negotiations.

“However, we regret the difficulty and inconvenience this process caused our patients,” said Shawn Mawhiney, a Hartford Healthcare spokesman.

Anthem, one of two insurance providers that offers policies via the state Affordable Care Act exchange, Access Health CT, has seen an 11 percent drop in sign-ups through the exchange from last year, according to an Access Health CT spokeswoman.

The open enrollment period for buying health insurance through the exchange began Nov. 1.

“AHCT doesn’t know why there is a difference at this time,” Access Health CT CEO, Jim Wadleigh said in an emailed statement.