Anthem Waives Contract Clause That Hindere

[skytrekker]

A state-run health insurance program may have an easier time contracting with hospitals after the state's largest insurer agreed to waive a clause in its own contracts.

Anthem Blue Cross and Blue Shield in Connecticut has a "most favored nation" clause in its contracts with medical providers that requires hospitals to offer Anthem the same or better discounts offered to other insurers. Anthem's arrangement has made it difficult for the state-subsidized Charter Oak health plan program to secure contracts with hospitals.

Last month, Attorney General Richard Blumenthal asked Anthem to exempt Charter Oak, a program for uninsured adults that serves about 13,000. Anthem waived the clause on Wednesday, said Anthem spokeswoman Sarah Yeager.

"This agreement enables hospitals to freely accept Charter Oak without fear of financial repercussions from Anthem for breach of contract," Blumenthal said Thursday.

Yeager said Anthem never intended to have hospitals pay Anthem at Charter Oak's reimbursement rates.

"Anthem supports efforts and initiatives that expand health coverage to Connecticut's uninsured and underinsured populations," Yeager said.

In 2008, the state started offering the Charter Oak health plan to provide coverage to uninsured adults between 19 and 64. The state contracted with three private insurance plans — Aetna Better Health, AmeriChoice by United HealthCare and Community Health Network — to manage networks of doctors and hospitals for the Charter Oak plan. In December, 17 of 32 hospitals in Connecticut had agreements with Charter Oak insurers — none in Windham or Middlesex counties.

Blumenthal has an ongoing investigation into Anthem's most-favored-nation clauses, which he said in December undermined competition and deterred hospital enrollment in Charter Oak.

"I am pleased that Anthem has recognized the need to carve out Charter Oak from this clause, but have continued concerns about the potential anti-competitive impact on the health insurance market," Blumenthal said. "I commend the company for its continued cooperation in this important ongoing antitrust investigation."

In the summer of 2008, the state started offering Charter Oak as a state-subsidized health plan to provide coverage to uninsured adults between 19 and 64. The state contracted with three private insurance plans — Aetna Better Health, AmeriChoice by United HealthCare and Community Health Network — to manage networks of doctors and hospitals for the Charter Oak plan.

Charter Oak, as any government-subsidized program such as Medicaid and Medicare, typically pays less to hospitals than commercial insurers. The most-favored-nation clause would require a hospital to offer Anthem rates as low as those offered to Charter Oak. Hospitals can't afford to lose revenue from treating customers who have Anthem, which insures 1.5 million in Connecticut, by dropping the insurer to accept Charter Oak patients.

As of last month, hospitals that don't participate in the Charter Oak plan included Bristol, Danbury, Day Kimball in Putnam, Griffin in Derby, Johnson Memorial in Stafford Springs, Lawrence & Memorial in New London, Middlesex, Midstate in Meriden, Milford, Norwalk, St. Francis, St. Vincent's, Stamford, Waterbury and Windham.

[Delenn]

I have a question. Actually, I'm kind of mulling this over in my mind. Are all or any of these hospitals not for profit?

[skytrekker]

Answer to your question-nonprofit? I do not know.

Connecticut- under the 'Charter Oak Health Plan' is a Pioneer nationally-

offering a 'Public Option' for health care- meaning it is similar to Medicare.

The AG, of the state of CT- Richard Blumenthal- has made it clear that the amount of money paid by for profit and non profit entities- the state of Connecticut payment will be the same.

[Delenn]

but have continued concerns about the potential anti-competitive impact on the health insurance market,"

What other concerns are there?

Speak s-l-o-w-l-y.

I'm trying to make a comparison in my head of what is going on here and where I am at. I think those "continued concerns" might raise a different line of questioning that I hadn't thought of before and might keep me from feeling like I just got run over.

[skytrekker]

The Insurance companies have long had no competition---with a Governbment run health care program that is non profit they are upset.

[Delenn]

I've had a nap, perhaps I can restate my question better. I completely understand that the insurance companies are upset. Now, they have carved this out and this is good. This I get.

My question is what else is the AG looking for the insurance companies to do? When I initially read this line:

but have continued concerns about the potential anti-competitive impact on the health insurance market,"

my immediate assumption was that there are other things that they want the insurance companies to do that hasn't been completed yet. So, I was asking, if you knew, what the other things were.

[skytrekker]

I cannot truly answer your question

I ask you;

Why should anyone's health care be put at the mercy of competitive companies?

The Attorney General of the state has had a long history of fighting these Insurance companies- and feel as I do they need their anti trust violations terminated.

The Public option foe health care in this state see Charter Oak Health Plan

has rates as low as $93 a month----with no limits on pre- existing conditions-150 dollar yearly deductible.

a plan with Blue Cross that is similar for a 55 year old would cost over $700

[Wyody]

just injecting an aside:
insurance companies, cable companies, utilities, political parties ... they never really compete ... it's like the TV networks ... they merely conspire, continuously.
Thank God for the people at Reese's!

[skytrekker]

I agree! Wyody

[Delenn]

Skytrekker,

In all honesty, I want universal and Federal. This is not an area for the states to intervene as much as they want. At no time in history have I ever witnessed the States desire to exert authority unless it meant taking away from people. In every area when States come forward to demand rights it is to exclude, demonize, or deny constitutional rights to a population.

I scoured as much as I could earlier today to attempt to grasp what is happening in Connecticut. This is insurance exchange and the AG is right the contract clause is not going to be enough.

One of the insurance companies in Connecticut had decided to drop so many people anyway, so that they could make a profit. This is key. They drop them and these other people will more than likely pick up the subsidized health care but....the government and the hospitals are still going to negotiate. Exchange. Preference will still go to those who pay more. Treatments will still go to those who pay more. And for those that can't afford it? This is not health care reform.

The question before us is if health care is a right or a privilege. I believe it is a right and we have doctors that believe it is a right. From there, we go to should it then be privatized at all? Privatization in public spheres has had deadly consequences. Texas, Indiana, and Florida. You, your parents, your partner, your children or your great aunt Bessie twice removed cannot be the bottom line. NONE of it leads to socialized medical care.

I also came across an article that had a free health care for one day clinic ( in Connecticut). They ended up still sending away 25-30 people. I'm sure that there were others that didn't know, or could not make it. This ain't it.

Fact: private insurance companies are ripped off more then Medicaid. Medicaid pays a lower overhead. Connecticut does not have it going on. What I could not find and may have not looked in the right place is if there were penalties for not having insurance in this state.

Believe me, I would like to be corrected or maybe I missed something that I should be paying attention to here. Like I said, I'm making a comparison in my head and I don't live here so, you know?

[RVer]

Originally Posted by Wyody

just injecting an aside:
insurance companies, cable companies, utilities, political parties ... they never really compete ... it's like the TV networks ... they merely conspire, continuously.
Thank God for the people at Reese's!

I agree too. Probably because you are right. They do not compete, they conspire.

[skytrekker]

Delenn

I tend to agree with your last statement-however the possibility of the Federal Government passing Health care now is problematic--
The first steps they should try and pass include;

Expansion of medicaid to those up to 140% of poverty
End anti trust protection for insurance companies
end Insurance companies rights to deny or jack up rates for age or preexisting conditions
Some tort reform

Once this has been done a realistic framework should be started on universal health care including a 'Public Option' In reality the best and cheapest way to go is 'Single Payer' for all those without Insurance.

The states will have to take up the crusade- until our leaders at the Federal level keep trying to protect the Insurance companies.

Connecticut also has passed the 'Sustnet' Bill
which calls for health care that is given to state employees to be opened up to all those who are self employed or have no insurance-they will be ale to purchase from a large pool -hence far lower costs then if purchased by someone like Blue Cross. Those being very low income will be given subsidies.

This will become law here in CT in 2 years- for new we have the Charter Oak Health Plan that will be phased out once Sustinet becomes working.

[Delenn]

I still think that they should be dropped. I see no reason why we should be asked to support an industry that has done nothing but jack people consistently.

[skytrekker]

Originally Posted by Delenn

I still think that they should be dropped. I see no reason why we should be asked to support an industry that has done nothing but jack people consistently.

Write your Congressmen/Congresswomen

tell them- the Fox News/Tea Bag/Insurance Company Lobbyists have won.

[Delenn]

The response from my congressman? "We can deal with the healthcare later, we need to focus on Afghanistan".

Skytrekker, I have to abandon your thread or have a fricken' stroke.

[skytrekker]

Originally Posted by Delenn

The response from my congressman? "We can deal with the healthcare later, we need to focus on Afghanistan".

Skytrekker, I have to abandon your thread or have a fricken' stroke.

Do not give up

The USA is a carbon copy of the British empire at the end of the 19th century

do prevail