CONNECTICUT, USA — A major Connecticut-based insurance company is reversing course on a controversial rate cut.
The expected cut by Anthem was criticized by therapy providers and families and would have impacted thousands of children with special needs.
FOX61 uncovered the issue and held Anthem accountable. They responded and, ultimately, Anthem decided to roll back a 30-65% provider reimbursement rate cut that was supposed to kick in Oct. 1.
Had the cuts gone into effect, it would have slashed the rates Anthem reimburses some therapy providers for essential special needs services like speech and feeding.
Anthem’s daily rate cap would have forced some providers to reduce the length of their appointments, split visits into multiple days or drop Anthem altogether. Families would have had to pay more out of pocket or find a new provider.
For four-year-old Hadley Purtell and 10-year-old Synnove Donofrio, individualized care providers have been their saving grace.
“How can you do this to these children? How can you take away their therapy?” asked Tia Donofrio, Synnove’s mom.
“There is a risk that Hadley will no longer be able to see her provider for continuing services here in Connecticut,” added Joanna Purtell, Hadley’s mom.
Both Synnove and Hadley have been working with speech and language pathologist Jennifer Hoskins. They have made remarkable growth.
“Most of the families out here that I treat are children on G-tubes or have significant feeding issues who have tried the traditional approaches and they haven’t worked,” said Hoskins.
For these families, specialized providers like Jen become part of their extended family. They become part of their circle of love and trust. Jen helped them when no one else would and helped them achieve goals no one thought possible.
“Everyone early on said she may never speak, she may never walk and here she is today doing both of those things,” said Purtell.
Sign up for the FOX61 newsletters: Morning Forecast, Morning Headlines, Evening Headlines
“These therapies. They’re not just beneficial, they are essential,” added Donofrio.
Anthem’s initial rate cut decision was about to force Hoskins to close her Connecticut practice.
“They don’t respect us,” Hoskins said, of Anthem.
Hoskins, like many, is a small specialized provider not equipped to negotiate rates. She is a small fish in a big provider pond. Providers attached to large hospital conglomerates are often able to negotiate rates four times better for the same services than providers like Hoskins due to their size and scope.
At the last minute, Anthem decided to make a change.
They responded to FOX61’s inquiry saying, “After further evaluation of speech therapy coding, we will continue to reimburse speech therapists at a fee-for-service rate instead of the proposed Oct. 1 rate change.”
“It’s a huge relief. We are so happy!” said Donofrio.
“Thankful. Relieved,” added Hoskins.
The Office of the State Healthcare Advocate told FOX61 it’s a temporary win.
“It is widely recognized as a broken system,” said Sean King, a state healthcare advocate staff attorney. “It is still a market driven system, and there are still a lot of incentives to make decisions that are not necessarily driven by the best interest of kids and families. They are driven by profit and money motivations.”
And despite Anthem’s reversal, there are still a lot of unanswered questions like what happens to the providers who already submitted a termination notice? Will the rate cut reversal ultimately result in higher premiums?
In 2023, Anthem Insurance brought in over $171-billion in revenue.
RELATED: Rate increases sought by insurance companies should be rejected: Connecticut Attorney General
RELATED: Beyond the Horizon provides advocacy, education and opportunity for those with different abilities
----
Matt Caron is a reporter at FOX61 News. He can be reached at mcaron@fox61.com. Follow him on Facebook, X and Instagram.
----
Do you have a story idea or something on your mind you want to share? We want to hear from you! Email us at newstips@fox61.com.
----
HERE ARE MORE WAYS TO GET FOX61 NEWS
Download the FOX61 News APP
iTunes: Click here to download
Google Play: Click here to download
Stream Live on ROKU: Add the channel from the ROKU store or by searching FOX61.
Steam Live on FIRE TV: Search ‘FOX61’ and click ‘Get’ to download.