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