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Conn. doctors left out of Anthem's "most-favored" policy waiver
■ Hospitals are spared from giving the insurer the same low rates they accept from a state plan. But physicians didn't get the same break.
By Emily Berry — Posted Feb. 17, 2010
Anthem of Connecticut has offered hospitals a waiver that will allow them to accept deeply discounted reimbursement from a state-subsidized public plan without having to give Anthem the same deal.
The step came at the urging of the state's attorney general, Richard Blumenthal, who said his office continues to investigate the use of what are referred to as "most-favored nation" contract clauses.
Such contract terms, which bar a doctor or physician from giving another payer better discounts, are illegal in at least 12 states. They are legal in Connecticut.
Anthem is the Connecticut subsidiary of WellPoint. According to Blumenthal's office and the state medical society, Anthem inserts most-favored-nation language into some contracts with both hospitals and doctors in Connecticut.
Charter Oak Health Plan is a state-subsidized health plan for adults that uses commercial health plan contractors, including Aetna and UnitedHealth Group. Anthem is not one of the contractors. About 13,000 people are enrolled in the program.
According to Blumenthal's office, hospitals were afraid to participate in Charter Oak because they were convinced that Anthem would demand the same rates. The problem diminished the Charter Oak network to the point that in some counties, there were no available network hospitals.
Blumenthal wrote to Anthem in December 2009 to ask the company to assure hospitals that it would not expect discounts equal to those granted to Charter Oak.
On Jan. 28, the attorney general said Anthem had agreed to do so, but physicians were left out of the picture.
"The waiver is specific to hospitals," Anthem spokeswoman Sarah Yeager said in an e-mailed statement.
Matthew Katz, executive vice president at the Connecticut State Medical Society, said the organization has long opposed the use of most-favored-nation clauses and called on Anthem to eliminate their use.
"This is a step in the right direction, but why haven't they released physicians from those terms in their contracts, and why do they have them in the first place?" he said.
