Blumenthal pleased with Anthem situation

Nick Rees Mar. 3, 2010, 4:10pm


HARTFORD, Conn. (Legal Newsline) - Following an agreement with Anthem Blue Cross and Blue Shield, Connecticut Attorney General Richard Blumenthal has announced that every county in the state now has a hospital participating in the state's health plan for the uninsured.

Only 17 of 32 hospitals in Connecticut had executed agreements to participate in the state's Charter Oak Health Plan for the uninsured earlier this year and no hospitals in Windham or Middlesex counties were participating.

After reaching an agreement with Anthem in late January, however, three hospitals that were critical to strengthening the Charter Oak program - Windham Hospital, Day Kimball Healthcare and Middlesex Hospital - agreed to join the program, Blumenthal says.

"This recent expansion - directly resulting from our agreement with Anthem - bolsters the success of Charter Oak and its mission to provide coverage to thousands of uninsured citizens in Connecticut," Blumenthal said.

"Our agreement with Anthem has enabled hospitals to freely accept Charter Oak without fear of financial repercussions from Anthem for breach of contract."

The hesitancy to join the program stemmed from clauses in Anthem's contracts, called "Most Favored Nations" clauses, that would require hospitals to provide Anthem with discounts at least as favorable as any provided to its competitors.

Anthem agreed last month to waive the Most Favored Nations clause for Charter Oak, which allowed hospitals to freely accept Charter Oak without the fear of financial repercussions from Anthem for breach of contract.

"I again commend Anthem for reaching an agreement with our office to ensure the success of Charter Oak - which is critical now more than ever as the ranks of uninsured grow during this economic downturn," Blumenthal said. "This growing number of hospitals participating in Charter Oak further solidifies the success of this program by ensuring a participating hospital in every Connecticut county."

The Connecticut Department of Social Services administers Charter Oak as part of a plan to provide the uninsured with coverage. The state has contracted with Aetna Better Health, AmeriChoice by UnitedHealthcare and Community Health Network of Connecticut to coordinate benefits in a managed care program and to establish provider networks for health professionals and hospitals.

Hospitals that agree to participate in Charter Oak must accept discounted rates for services and treatment for Charter Oak members that are much steeper than the rates hospitals generally accept for commercial business.

More News