Anthem’s Negotiations with Stamford Health in Connecticut: What Our Members Need to Know
November 14, 2024December 2024
Stamford Health is already one of the most expensive places to get care in Connecticut. Now, it’s demanding price increases more than double the rate of inflation for the next three years. Connecticut families and employers can’t afford these drastic price hikes.
Stamford Health notified Anthem Blue Cross and Blue Shield in Connecticut (Anthem) that it intends to leave our network on January 1, 2025. State law automatically extends the reimbursement rates from the existing agreement for 60 days after the contract ends. That means Anthem will pay Stamford Health in-network rates through March 1, 2025. If we do not reach a new agreement, care received at Stamford Health will be reimbursed as out of network for members covered by employer-based, individual, Federal Employee Program, and Medicare Advantage plans after March 1, 2025.
Why is this happening?
Anthem and Stamford Health are currently working to reach a new multi-year contract that will allow our members to continue accessing care at Stamford Health after March 1, 2025. Stamford Health is demanding large price increases every year that are more than double the inflation rate. Stamford Health is already one of the most expensive health systems in Connecticut with prices 30 percent higher than other systems. If Anthem accepted these demands, healthcare costs would increase by $45 million for Connecticut consumers and employers over the next three years. That means higher out-of-pocket costs and higher premiums for members.
Here's how Stamford Health’s price increases would impact your costs by 2027:
- $9,899 more for a knee or hip replacement
- $4,839 more to deliver and care for a baby
- $1,015 more for an emergency room visit
- $815 more for a CT scan and $673 more for an MRI
These higher costs would hit employers hard as well. More than 70 percent of Anthem members in Connecticut are covered by employers who directly pay their employees’ healthcare bills. That means that Connecticut employers would feel the full burden of these price increases – hampering their ability to raise pay, offer benefits, and hire new workers.
What did Anthem offer?
Anthem has offered reasonable and fair payment that keeps healthcare affordable for our members. These increases are in line with what other Connecticut health systems receive. So far, Stamford Health has refused these offers.
If Stamford Health does leave our network, Anthem members will experience much higher costs for non-emergency care at Stamford Health facilities and doctors starting March 2, 2025. Please see below for more information about the many alternate healthcare providers in our network.
Will you reach an agreement?
That is our goal. Anthem will continue to work hard to negotiate a new contract with Stamford Health before March 1, 2025. Please continue to check this site for updates.
Which hospitals/facilities are included in this negotiation?
- Stamford Hospital in Stamford, CT
- Stamford Health Medical Group (multiple locations)
- Stamford Health-Norwalk Radiology in Norwalk, CT
- All Stamford Health physicians and services
What should I do if I need emergency medical care from Stamford Health?
A hospital’s emergency medical services do not require pre-authorization, regardless of where they are delivered. Anyone in need of emergency care should go to the nearest emergency room or call 9-1-1. Coverage will be provided according to your policy benefits and is subject to in-network cost shares.
What if I’m currently being treated at Stamford Health?
Please note there are no immediate changes to our members’ health plans at this time. We know this is especially concerning for our members currently receiving care at Stamford Health. That’s why we’re taking steps to help in the event Stamford Health leaves our network. If you are a member receiving treatment for a serious or complex condition that will continue past March 1, 2025, please contact our Member Service Center at the number on your Anthem ID card. You may be able to continue your care at Stamford Health for a limited time after that date if you are receiving certain types of care.
Where can I go for care if Stamford Health leaves Anthem’s network?
We are working hard to come to an agreement so members can continue their care at Stamford Health beyond March 1, 2025. In addition to other hospitals in Fairfield County, we also have hundreds of high-quality providers in the area that can serve your health needs.
We are working hard to come to an agreement so members can continue their care at Stamford Health beyond March 1, 2025. In addition to other hospitals in Fairfield County, we also have hundreds of high-quality providers in the area that can serve your health needs.
Nearby hospitals include:
- Greenwich Hospital in Greenwich, CT
- Bridgeport Hospital in Bridgeport, CT
- St. Vincent’s Medical Center in Bridgeport, CT
- Norwalk Hospital in Norwalk, CT
- Danbury Hospital in Danbury, CT
Members can use the Sydney Health mobile app or anthem.com to find doctors near them. Members can also contact Member Services through Sydney Health or by calling the number on their Anthem ID card for assistance finding a new provider in their area.
What if I have further questions?
Please check this site for updates on our work to come to an agreement with Stamford Health, or call the Member Services number on the back of your Anthem ID card.
