Opportunities to Protect Connecticut Consumers During Insurer-Provider Contract Negotiations
Long-standing health care relationships are at risk from unpredictable network disruptions. Time and time again, health care insurance and provider contract negotiations threaten to upend the lives of Connecticut residents who are caught in the middle. Health care consolidation worsens the problem and deepens the concerns. If you’ve never been one of the thousands of consumers standing by helplessly while hospital systems and insurers determine the fate of your health care access behind closed doors, you may know someone who is impacted, or you just feel bad about it because it could easily be you or someone you love.
Connecticut state and federal legislators have at least 4 opportunities to address this dysfunctional cycle and protect consumers (and employers) when health insurers go out of network in plans for which the state or federal government can exercise regulatory authority:
- Close the network adequacy loophole,
- Include all lines of health insurance business in the “cooling off period”,
- Extend the “cooling off period”,
- Require insurer posting of insurer/provider contract expiration dates, and
Some people just shrug and say the payer and provider will eventually duke it out, they need each other, and they will likely settle. But what will the result mean for the direction of cost and quality of our health care? And how do we fix the cycle of disruption in health care?
Consumers are helpless to know or even weigh in. We hold our collective breath. Some people change doctors or health plans, unable to wait for a determination on a new contract. Once negotiations are complete, the parties congratulate one another and move on as they usually do, tone deaf to the permanent public wreckage they’ve created and nurtured through the process and ignoring the devastating impact on patients, who they expect to be relieved and grateful it is over. Until the next time.
There seems to be no apology and zero consideration for the cumulative irreparable reputational damage inflicted time and again through a process which is exacerbated by scare tactics that use patient safety, quality, and affordability as negotiating tools. On average, Connecticut consumers (and employers) pay almost $25,000/year in health insurance premiums, triple what they paid two decades ago[1] when insurer/provider “networks” were just getting into full swing and delivery systems were less consolidated and had less negotiating power than they do now. Network contract negotiations traumatize all consumers and erode our trust. Consumers understand that they can easily have the in-network rug pulled out from under them at a time when they need to rely on their insurance, part way through their enrollment year, at the hospital they may have depended upon for decades.
While payers and providers are wrestling together in muddy negotiations, expecting consumers to be only passive sideline spectators to their high-stakes drama, we must consider how we break this cycle of dysfunction and erosion of credibility in health care.
How can Connecticut and the federal government better protect the rights of consumers, improve their trust in payers and health systems, and address the cycle of harm?
First, we can lessen the fear factor inflicted on consumers and provide better protection. During the months consumers are confined to an insurance enrollment period, “bait and switch” of provider network status changes should not be allowed. As in any legal contract, at the beginning of the insurance contract year, the consumer (and/or employer) agrees to pay premiums in exchange for these factors: defined health coverage, cost sharing (deductibles, co-insurance, etc.), and publicly listed in-network providers. If in-network provider status changes due to an unrelated contract dispute between the provider and the insurer, the consumer contract with the insurer should not be affected. Listed in-network providers should be grandfathered in for consumers for the duration of their insurance enrollment contract because they relied on that information to form a valid contract.
But network adequacy is a term that has been used to scuttle this basic tenant of contract law – that if material provisions are changed, the contract becomes null and void. Instead, network adequacy traps consumers in insurance plans, usually not allowing them the right to join a new plan until the next open enrollment opportunity, unless a rare “special” enrollment period is granted.
Essentially network adequacy says that if the insurer has adequate providers in-network that can deliver the same or similar services, then the insurers can substitute them for each other. For example, if UHC removes HHC after three months in an enrollment year, perhaps St. Francis Hospital is in the UHC network as a “substitute” hospital. But what if a consumer didn’t join UHC for St. Francis, they joined specifically for HHC? And not just for convenience, but because of a history of critical health needs.
- Close the network adequacy loophole
If future Connecticut law closes the network adequacy loophole in policies for which it has regulatory authority, and this is implemented in federally regulated plans, we can ensure that a network is only “adequate” if it includes all the providers marketed and promised at the beginning of the agreement through the entirety of the enrollment term covered by that agreement. In other words, if the provider is on the posted in-network list in January, and the consumer cannot enroll in a different insurance until the following January, the provider can’t disappear off the in-network list part way through the year unless the provider refuses to serve the patient. Even if the insurer/provider contract terminates, the agreement between the consumer and the insured cannot be altered and still be valid.
- Include all lines of health insurance business in the “cooling off period”
Providers and insurers should negotiate contracts that do not allow consumers to fall off the in-network coverage cliff at the moment of contract expiration. For example, in the contract between Hartford Healthcare and UnitedHealthcare, as soon as the contract expired on March 31, 2025, Medicare Advantage patients went out-of-network because the cooling off period did not apply under the contract that had been previously negotiated. In contrast, the contract negotiated between UCONN Health and Connecticare, that expired on April 15, 2025, was negotiated to protect every consumer and included all lines of health insurance business in the 60 day cooling off period, including Medicare Advantage plans, so that no patients would suffer unfairly from the application (or lack thereof) of the cooling off period.
- Extend the “cooling off period”
Currently, Connecticut has a “cooling off period” which is 60 (very long and stressful) days from the date of the insurer/provider contract expiration. It allows for in-network coverage to continue for some consumers while the insurer and provider continue to negotiate. However, the “cooling off period” should be extended beyond 60 days until the consumer is allowed to exercise a new enrollment period and a new insurance coverage contract. Forcing in-network providers to exit in the middle of an enrollment contract between the consumer and the insurer is not only a bait and switch for consumers, it results in a material change to the original insurer/consumer agreement and makes the consumer a significantly unfair and unethical bargaining chip for both the insurer and the provider.
Additional thought would have to go into the “cooling off period” terminology (“wind down” or “tail”) and insurance compensation for the provider, if the insurer/provider contract expires, but the point of further discussion is to protect the expectations and needs of the consumer until they can make a new enrollment choice.
- Require insurer posting of insurer/provider contract expiration dates
At the very least, insurers should be required to post negotiated contract expiration dates next to the listed in-network providers on their websites and other marketing materials. Consumers (and employers) access provider lists when they weigh decision factors about future health insurance coverage enrollment. Insurers and providers may call an expiration date requirement “fear-mongering”, making people needlessly concerned. Maybe insurers and providers will negotiate new contracts smoothly and there will be no need to send out those dreaded letters that a contract may end. But consumers should have the right to know if a contract may possibly end mid-year so that they can factor it into their best-informed decision when spending $25,000/year on health insurance. Insurers and providers should not deny that information to them. If the network adequacy definition does not change, and the cooling off period is not extended, at least consumers can be informed so that they can know they’re facing a potential conflict dispute instead of blind-siding them after the fact in the middle of an enrolled insurance term.
In summary, someone once said, if you’re not at the table, you’re on the menu. Consumers are not at the table during insurer and provider contract negotiations, but they are on the menu as those who are at the table serve up fear and frustration to consumers. This current process only makes all of us, individually and collectively, less healthy. Let’s continue to discuss how to improve the health care experience and include the consumer perspective.