Connecticut Children’s Medical Center, Anthem agree on contract

Connecticut Children's Medical Center and Anthem Blue Cross Blue Shield reached an agreement Tuesday resolving a contract dispute that meant patients with Anthem health insurance could not receive coverage for their care at the hospital.

The contract lapsed in early April, resulting in families being charged out-of-network costs for services at the medical center, which provides pediatric care at its hospitals in Hartford and Waterbury as well as at facilities in Farmington, Glastonbury, Shelton and other locations. The insurer and the hospital had been at an impasse over reimbursement rates.

Under the new multiyear agreement, the hospital and its affiliate, the Connecticut Children's Specialty Group, will rejoin Anthem's network of participating providers, and covered services will be paid by the insurer on an in-network basis. Terms of the new contract were not released.

The agreement is a relief to many families with children who receive speciality services at the hospital and its affiliate.

Many of these services are available at only one other provider in the state, Yale-New Haven Hospital.

"We truly understand the impact that this situation has had on children and families and we are pleased to have reached a resolution," Martin Gavin, hospital president and chief executive officer, said in a joint statement from the hospital and Anthem.

State Comptroller Kevin Lembo said in a statement that he was pleased with the resolution but that the prolonged dispute "underscores the growing cost of health care.

"These heated - and unacceptably long - negotiations are a stark reminder that the spiraling cost of health care is defying historic reimbursement models," he said. "It should be a stark signal that Connecticut must be prepared to aggressively continue reform at the state level, regardless of how the U.S. Supreme Court rules on the federal Affordable Care Act."

Gov. Dannel P. Malloy also applauded the agreement, calling it "excellent news for the many families who rely on both Anthem and the Connecticut Children's Medical Center to care for their children."

Anthem and the hospital said that claims for Anthem members who received services from the hospital or specialty group from April 16 to June 11 will be paid as in-network benefits.

"We are pleased our members will again have access to Connecticut Children's and its specialty group," said David Fusco, Anthem president. "We believe we have reached the right deal, including initiatives that support our collective efforts to improve quality and outcomes."

j.benson@theday.com

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