CT health system's contract with insurer has expired. What patients need to know about their coverage.
Farmington-based UConn Health's contract with insurer ConnectiCare expired Tuesday with the two sides still at odds in negotiations over a new agreement, raising the possibility that patients covered by the health insurer could lose their 'in-network' status with the health system's hospital, clinics and doctors.
The negotiations between UConn Health — the parent of John Dempsey Hospital, a network of clinics and more than 600 providers — and ConnectiCare are focused on the reimbursement rate for services. UConn Health said its rate is the lowest, behind all hospitals in Connecticut, despite revenue growth in the last decade and rankings that place it in the top tier of hospitals nationwide.
'It's important that we receive fair compensation for the amazing services we provide,' Dr. Andrew Agwunobi , UConn Health chief executive said, in an interview. 'Our situation is that the payment is so low, it's unfair to providers, patients and taxpayers in Connecticut.'
The contract negotiations cover ConnectiCare's commercial coverage, which includes employer-sponsored plans, and Medicare Advantage plans, which are sold by private insurers and offer Medicare coverage plus additional benefits.
Even though the current contract has expired, the two sides are now entering a 60-day 'cooling off' period that concludes June 14 in which patients with ConnectiCare coverage with remain in-network. Contract negotiations will continue with the goal of reaching an acceptable agreement with ConnectiCare, Agwunobi said.
In a letter to The Courant, Farmington resident Felicia DeDominicus wrote that she was distressed about the potential end of coverage because her parents, who are 87 and 89, receive nearly all their medical care through the health center.
'My parents' [UConn Health] providers truly care about them, and we feel that caring,' DeDominicus wrote. 'We all trust these compassionate doctors at this vulnerable time in my parents' lives.'
DeDominicus urged all patients of the health center to voice their concerns about the possible loss of coverage, noting that losing coverage at the hospital would be devastating to her family.
'ConnectiCare should pay UConn Health fairly for the world-class doctors and the care that they provide,' DeDominicus wrote.
If a patient is forced out-of-network, the implications could be far-reaching.
According to healthinsurance.org, depending on the health plan 'expenses incurred for services provided by out-of-network health professionals may not be covered at all unless it's an emergency. Or they may be covered but with higher out-of-pocket costs than the member would pay for same care received from an in-network provider.'
In addition, 'the federal cap on out-of-pocket costs only applies to in-network care (and only care that's considered an essential health benefit). So out-of-pocket costs for covered out-of-network care can be much higher, or even unlimited. And, it's important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share.'
Consumers who find themselves out-of-network may be forced to find new health care providers that are in-network.
UConn Health said there can be exceptions for 'continuing care' such as chemotherapy treatments that remain in-network even in the absence of a contract.
ConnectiCare, headquartered in Farmington, was acquired by California-based Molina Healthcare on Feb. 4. Both ConnectiCare and Molina did not respond to emails Tuesday seeking comment.
UConn Health — an arm of the University of Connecticut — also oversees the university's medical and dental schools, plus its medical research. In the current fiscal year, UConn Health received about $193 million in state funding, or 12.5% of its total budget, Agwunobi said.
A standoff between hospitals and health insurers is not unusual in negotiations.
In December, for instance, Trinity Health of New England reached an 11th-hour contract agreement with Aetna, owned by CVS Health Corp., to continue in-network coverage.
Kenneth R. Gosselin can be reached at kgosselin@courant.com.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Politico
an hour ago
- Politico
Adams administration changes course on Medicare Advantage
Beat Memo Mayor Eric Adams announced he will not move forward with a contentious effort to cut costs by shifting retired city workers to a Medicare Advantage plan, bringing a sudden end to a four-year saga. 'We have heard concerns from retirees about these potential changes at numerous older adult town halls and public events, and our administration remains focused on ensuring that New York City remains an affordable place to live,' Adams said in a statement Friday. Just two days earlier, the state Court of Appeals ruled in City Hall's favor in a lawsuit over the Medicare Advantage transition, handing Adams a rare win in the long legal battle to implement a plan he inherited from former Mayor Bill de Blasio. But Adams said the city had found other ways to address health care costs. He did not offer specifics, but City Hall announced a plan earlier this month to save $1 billion annually by designing a new health coverage option with EmblemHealth and UnitedHealthcare for the majority of active city workers. 'Since the mayor has decided not to proceed with the Medicare Advantage plan, this fulfills the unions' obligation to generate Medicare-eligible retiree health care savings,' Henry Garrido, executive director of public employee union DC 37, said in a statement. 'The savings from the abandoned plan must not come at the expense of our members.' Many elected officials applauded Adams' decision, which comes shortly before a planned kickoff event for his reelection campaign. Local lawmakers and municipal retirees plan to celebrate the news today in City Hall Park, but they are already eyeing their next steps: continuing to lobby for legislation that would permanently protect their health benefits. The bill, which is spearheaded by Council Member Christopher Marte, has 17 co-sponsors. 'While this decision is welcome, we have to codify our success,' Marte said in a statement. 'Our retirees deserve certainty, dignity, and care—not corporate shortcuts and backroom deals.' ON THE AGENDA: — Thursday at 11 a.m. The state will hold its annual forum on the 1332 waiver. — Thursday at 3 p.m. NYC Health + Hospitals' board of directors meets. GOT TIPS? Send story ideas and feedback to Maya Kaufman at mkaufman@ and Katelyn Cordero at kcordero@ Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You'll also receive daily policy news and other intelligence you need to act on the day's biggest stories. What you may have missed — The state plans to bar health insurance companies from paying brokers a commission for enrolling people in the Essential Plan starting next year, POLITICO Pro's Maya Kaufman reported. Independent insurance brokers are mobilizing in opposition to the little-noticed policy change, which was tucked into a 73-page information booklet for health plans about 2026 participation in the NY State of Health insurance marketplace. Odds and Ends NOW WE KNOW — Melanoma cases are on the rise in women under 50. TODAY'S TIP — Get ready for scorching temperatures this week by taking these precautions. STUDY THIS — Via WaPo: The 'sitting-rising test' could be an early indicator of how long you'll live, according to new research. What We're Reading — Insurers pledge to ease controversial prior approvals for medical care. (New York Times) — More employers are giving workers money to buy their own health insurance. (AP) Around POLITICO — CMS finalizes plan to narrow Obamacare enrollment and DACA sign ups, David Lim reports. — Via POLITICO's Jordan Cairney: Provider tax crackdown is a no-go in the House, Hawley warns. MISSED A ROUNDUP? Get caught up on the New York Health Care Newsletter.
Business Wire
an hour ago
- Business Wire
New Study Finds Senior Patients Managed by Women Physicians in a Value-Based Care (VBC) Model Have Equal or Better Clinical and Quality Outcomes and Less Healthcare Utilization
WESTERVILLE, Ohio--(BUSINESS WIRE)--agilon health (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, today announced the publication of new peer-reviewed data examining the impact of gender differences of primary care physicians (PCPs) on patient outcomes, healthcare utilization and revenue using different Medicare payment models, specifically value-based care (VBC) and fee-for-service (FFS). Research was published in the May 16, 2025, issue of the JAMA Health Forum. In the study, researchers identified nearly 900 PCPs, of whom 40% were women, at 15 practice groups across seven states who deliver care through agilon's VBC model. Researchers then examined claims data from approximately 225,000 Medicare Advantage (MA) patients who were treated by these physicians, as well as the corresponding Stars quality data from national and regional payors. When comparing men and women PCPs in the same practice groups, researchers found that patients managed by women PCPs in a VBC model experience equal or better clinical and quality outcomes and less healthcare utilization, and the women physicians earned more per patient. 'The reversal of the gender gap under value-based payment implies that these models may be better aligned with desirable practice patterns that are more common in women, like spending more face-to-face time with patients in office visits,' said study author Ishani Ganguli, MD, MPH, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Specifically, researchers observed the following: Outcomes: Senior patients managed by women PCPs experienced better key clinical outcomes, as evidenced by better hemoglobin A1C control and receipt of more eye exams for those with diabetes, compared to patients seen by men PCPs. Of note, similar patient outcomes were observed for blood pressure control and adherence to statin medication for cholesterol management between the two groups. In terms of quality scores, women PCPs had higher composite Stars quality scores, but lower provider rating scores than their men counterparts. Utilization: While the number of primary care visits were similar between the two groups, visits to the emergency room (ER) and hospitalizations were substantially lower for patients seeing women PCPs compared to those seeing men PCPs. Revenue: Compared to men PCPs in their own practice groups, women PCPs earned more per patient in the VBC model and similar amounts under the FFS model. 'As a woman physician, I believe VBC allows us the opportunity to leverage the relationships we develop with our patients, which correlates to improved outcomes, and the ability to be paid because of those important connections,' said study author Victoria DiGennaro, DO, Pioneer Physicians Network, Akron, OH. 'Our partnership with agilon health and implementation of its VBC model have been instrumental in enabling both of those to happen.' agilon's VBC model, which puts the physician at the center, is known as the Total Care Model. The Total Care Model takes the same physicians, the same patients and the same payors, and moves them from the challenges of FFS into a total care relationship, which results in high-quality care and improved patient clinical and quality outcomes, lower healthcare costs and healthier communities. It encompasses long-term partnerships, a purpose-built platform and a Physician Network that helps physicians overcome obstacles and transition to VBC. 'In addition to agilon's Physician Network, another benefit of our partnership has been the focus on women physicians, which includes a Women Physician Leadership Council,' added Dr. DiGennaro. 'Many women physicians want to practice medicine as they were trained, while finding that critical work-life balance, and I'm proud to be a voice for them through my involvement on the Council.' Study design In this cross-sectional study, researchers examined PCPs with primary care specialties who participated in agilon's Total Care Model. A total of 872 PCPs (352 of whom were women) working in 15 practice groups in seven states (Ohio, Texas, New York, Pennsylvania, Connecticut, North Carolina and Michigan) were included, along with 223,810 MA patients. Women and men PCPs had similar education, years of experience and specialties. There are several limitations to the study. First, results may not generalize beyond physicians who participate in risk arrangements. Second, MA patients represent only a portion of doctors' patient panels. And, finally, researchers cannot observe how individual practice groups translated MA payments to take-home wages (though comparing PCPs within the same practice groups mitigates this concern). About agilon health agilon health is the trusted partner empowering physicians to transform health care in our communities. Through our partnerships and purpose-built platform, agilon is accelerating at scale how physician groups and health systems transition to a value-based Total Care Model for their senior patients. agilon provides the technology, people, capital, process and access to a peer network of 2,200+ primary care physicians that allow its physician partners to maintain their independence and focus on the total health of their most vulnerable patients. Together, agilon and its physician partners are creating the healthcare system we need – one built on the value of care, not the volume of fees. The result: healthier communities and empowered doctors. agilon is the trusted partner in 30 diverse communities and is here to help more of our nation's leading physician groups and health systems have a sustained, thriving future. For more information, visit and connect with us on LinkedIn.
Yahoo
an hour ago
- Yahoo
Major Health Insurers Agree to Simplify Prior Authorizations
Major U.S. insurers said they would streamline the prior authorization process. Health insurance trade association AHIP said the changes would be implemented across insurance markets, including commercial coverage, Medicaid managed care, and Medicare Advantage plans, and benefit 257 million Americans. "The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," AHIP CEO Mike Tuffin said. "Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system." The changes would affect patients covered by insurance providers that include CVS Health (CVS), UnitedHealth Group's (UNH) UnitedHealthcare, Cigna (CI), and Humana (HUM). The move comes after the murder of UnitedHealthcare CEO Brian Thompson last December brought attention to the prior authorization process. Read the original article on Investopedia Sign in to access your portfolio
