State Healthcare Advocate’s Request For Hearing Sparks Debate With Insurance Department

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The state Healthcare Advocate on Friday requested a hearing to examine how Anthem Blue Cross and Blue Shield in Connecticut is calculating its proposed rates for 2015 coverage.

Health insurers submitted their proposed rates for 2015 coverage by the May 31 deadline, and the regulating agency, Connecticut’s Insurance Department, posted summaries of the requests on its website this week at www.ct.gov/cid. The department has the authority to review, approve, modify or reject insurance rates.

Anthem is the state’s largest insurer. It is requesting rates that are, on average, 12.5 percent greater than this year’s insurance prices. Similarly, ConnectiCare is asking for rates that are 11.8 percent more than this year’s prices, on average. A relatively new insurer in the state, HealthyCT, is asking for a price decrease of 8.9 percent.

To shine a light on how Anthem arrived at the price increase, State Healthcare Advocate Victoria Veltri sent a letter Friday to the Insurance Department asking for a hearing. A 2011 agreement between Veltri’s office and the Insurance Department allows the health care advocate to request as many as four hearings each calendar year on rate requests of 15 percent or more.

Veltri’s request touched off a disagreement between her office and the Insurance Department about whether the terms of the 2011 agreement permit her to call for the hearing in this case. The department, however, has agreed to go forward with a hearing.

“We were surprised to receive this as we do not believe it meets the spirit of the 2011 agreement, (in which the Department grants OHA the limited authority to call four rate hearings in a calendar year)however the Department is willing to hold the hearing on the filing for the individual market,” Deputy Insurance Commissioner Anne Melissa Dowling wrote in an e-mail to The Courant.

At the heart of the issue is the rate review process, in which insurance companies ask to revise prices on medical coverage. In the fall of 2010, the Insurance Department approved rate increases as high as 47 percent on some health plans, sparking public outrage.

Later that year, then-Insurance Commissioner Thomas Sullivan took a private-sector job. An acting commissioner took Sullivan’s place for a short time until Gov. Dannel P. Malloy appointed Insurance Commissioner Thomas B. Leonardi in early 2011.

In August 2011, with the high rate approvals of the previous year fresh in everyone’s memory, the Office of the Healthcare Advocate and the Insurance Department reached an agreement allowing the advocate to call for hearings.

The intent of the agreement, however, was up for debate Friday.

“The Insurance Department believes it was not the intent of the 2011 agreement to parse the overall base rate submission as a means of having rate hearings on individual plan designs but rather was to afford a hearing opportunity when the base rate was 15% or more,” Dowling wrote in her e-mail.

After reading Dowling’s response, Veltri said: “Construing this agreement so narrowly could result in a situation where a significant rate increase impacting thousands of individuals would result in the inability to request a hearing by right. For example, a plan comes in with an aggregate filing of 14.8% that represents a 2% rate increase of one plan that covers 1000 lives and a 15% rate increase for a plan with 50,000 members. It was certainly not the intent of the agreement to have such an absurd result in which a plan covering 50,000 lives would not be reachable through the agreement.”

Anthem spokeswoman Sarah Yeager said in a statement, “At Anthem Blue Cross and Blue Shield we are committed to being a valued health partner and delivering quality products and services that give consumers access to a range of affordable health care coverage options. Transparency is important to us. As always, we will cooperate fully throughout the rate filing process and welcome the opportunity in any forum to ensure that all stakeholders have the information they need to understand the factors that support our proposed rates.”

About Matthew Sturdevant

Full-time staff journalist at The Hartford Courant and magazine freelancer with a master's degree in writing from Dartmouth. My work has appeared in The Los Angeles Times, The Chicago Tribune, Taiwan News, The Baltimore Sun and many other news sources. My blog has been referenced by Politico.com, the Kaiser Family Foundation, the Georgetown Law Library and a number of organizations in healthcare and business. Sturdevant’s blog is "a well-written wealth of ideas," said The Donald W. Reynolds National Center for Business Journalism, (businessjournalism.org, May 18, 2011). I have experience writing for newspapers, magazines, Web sites and blogs as well as shooting and editing video. I made regular appearances on news-talk radio and on the NBC affiliate station in Corpus Christi, Texas. I made occasional appearances on the Fox affiliate in Connecticut promoting Hartford Courant articles.

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