Major insurer stops covering St. Raphael’s

Completion of the merger between Yale-New Haven (above) and St. Raphael's Hospitals will eliminate a current impasse between St. Raphael's and an insurance provider.
Completion of the merger between Yale-New Haven (above) and St. Raphael's Hospitals will eliminate a current impasse between St. Raphael's and an insurance provider. Photo by Jacob Geiger.

The contract between Saint Raphael’s Hospital and the health insurance provider Cigna expired on Wednesday, Oct. 19, forcing some New Haven residents to re-evaluate their current plans for medical treatment.

From now on, the insurance company will not cover any hospital costs of those it insures if they receive care at Saint Raphael’s. Although Yale-New Haven Hospital and St. Raphael’s signed a letter of intent to merge in September, some Cigna members will need to switch hospitals until the process is finalized. But while local residents are adjusting their plans for treatment, spokespeople from the insurance company and the hospital blame the recession for their current failure to renegotiate the contract.

“Cigna and the Hospital of St. Raphael have been negotiating their contract renewal, but have been unable to come to mutually agreeable terms,” Gwyn Dilday, a spokeswoman for Cigna, said. “The Hospital of Saint Raphael’s is a valued part of our network and we hope to continue our relationship; however, we have an obligation to protect the interests of our clients and customers and ensure that they have access to high-quality hospitals and doctors at a reasonable cost, especially during these challenging economic times.”

But while Cigna is citing the poor economy for the contractual breakdown, a spokesperson for the hospital said its physicians deserve adequate compensation.

“Cigna subscribers are our patients and rely on us and our physicians for care. In order for us to provide that care, we must seek rates that are reasonable and market competitive for the care we provide,” said Liese Klein, a spokesperson for Saint Raphael’s. “Saint Raphael’s and Cigna have a long-standing relationship and we are committed to successfully concluding this negotiation process.”

Cigna members who were hospitalized at Saint Raphael’s prior to Oct. 19 will remain covered for their hospitalizationas long as Cigna preauthorized the admission. Cigna members treated for most behavioral health issues will not be impacted by the continued negotiations, but members should to ensure their coverage, Dilday said.

Katherine Ciak, a local Cigna member under the continuity of care insurance program, said that she was negatively impacted by the contract’s expiration. Ciak said she was scheduled to undergo bypass surgery on Nov. 19 at Saint Raphael’s, an operation that costs around $25,000. Under Cigna’s rules, the surgery is only covered for patients who undergo a six-month weight loss program at the hospital, for which she paid herself. After finishing the program the day before the contract expired, she was informed that her insurance would no longer cover the operation, she said.

Ciak said she applied for re-evaluation, but her application was rejected. She said that she now has two options, either to pay for the surgery herself, or go to Yale-New Haven hospital — which Cigna still covers — and pay for the new tests herself.

“I don’t know what’s going to happen,” Ciak said. “Paying for the surgery is definitely not an option.”

Ten more participants in the weight loss program were also affected by the negotiations, Ciak said.

Ciak added that she cannot change insurance companies because Cigna is the only one offered by her husband’s employer.

Although Cigna is headquartered in Bloomfield, Conn., it operates insurance and administrative services throughout the world.

Comments

  • danielwasinger45

    There can be a difference between what you and a health insurance company consider healthy. Some insurers will say that you have a health condition if you smoke, are overweight, are taking prescriptions, or had a medical condition in the past. If this describes you, you may want to search and read “Penny Health” on the web.

  • anonymouz

    Most people receive their insurance through their employer, in which case they may have little choice of insurer. And most of the unemployed receive their insurance from the government rather than a private insurer. So, the current impasse probably will not change New Haven residents’ choice of insurer, since they may have little choice. They will, however, be more likely to receive their care at Yale New Haven than at St. Raphael’s. Just like the person interviewed says.

  • joey00

    I wonder if an operation at Yale would cost the same at St.Raphael’s ? Meaning of course the same operation.. Also,what would happen if a person let’s say gets hit by a car and is rendered unconscience, he gets driven via ambulance to St.Rays, his employer has Cigna for him/her. But they don’t take Cigna,what’s a dying person to do ?

  • mlr

    @joey00 May the force be with you.

  • The Anti-Yale

    Let’s hook-up health to the profit motive and call it “legislation” and see what happens to human beings who fall by the wayside.

    This is the America we have created, the America of Ebenezer Scrooge: “If they are going to die, let them do so, and decrease the surplus population.”

  • River_Tam

    This article is unclear. Is Cigna going to treat St. Raphael’s as an Out of Network provider, or simply deny all claims originating from them? The former is common. The latter is unusual.

  • joey00

    Well Mr.MLR , we will need all the blessings from The Force,Mel Brooks’ The Schwartz,we will need to say Novenas by the dozens,ahms to ohms and whatever else i unintentionally omitted. Because without any competition this YNHH will be out of control

  • August

    @River_Tam: If I understand this correctly it means Cigna will not cover any claims from St. Raphael’s.
    A similar situation came up a few years back with Aetna and Hartford Hospital. The two failed to reach an agreement so Aetna sent out letters warning it could happen and again when talks failed. The last letter stated something to the effect that they would cover nothing new done at Hartford and would only cover those with ongoing care for X many days. However, a few weeks later all Aetna members received a third letter saying an agreement had been reached and they would again cover Hartford Hospital.
    I get the feeling it’s some sort of tactic either the insurance companies or hospitals use to generate an outcry from the people to pressure one side to give in and make a new agreement.