NH hospital excluded from network to get hearing

CONCORD, N.H. (AP) — The New Hampshire Insurance Department will hold a public hearing to address a Rochester hospital’s concerns about being excluded from the network of providers for those purchasing individual health insurance plans under the federal health overhaul.

Frisbie Memorial Hospital President Al Felgar is fighting Anthem Blue Cross and Blue Shield’s decision to exclude his hospital and about 80 of the hospital’s physicians from its new provider network. He said Thursday he was prepared to sue if the insurance department denied his request for a hearing, but Deputy Insurance Commissioner Alex Feldvebel said Felgar will get a hearing. He noted, however, that New Hampshire law does not require all providers to be included in the network, and he emphasized that the state doesn’t regulate the contracting process.

The public hearing will focus on explaining the state’s network adequacy standards, Feldvebel said. Felgar also wants access to Anthem’s records about the process used to determine who participates in the network.

“The state had a responsibility on the biggest health reform bill ever passed in this country to have an open process,” Felgar said. “Nobody’s taking responsibility. The feds point to the state and the state points to the feds. This is unacceptable.”

Anthem is the only New Hampshire insurance company participating in the new online insurance markets required under President Barack Obama’s health care overhaul law. The new network will include 74 percent of the state’s primary care providers, 85 percent of specialists and 16 of the state’s 26 acute-care hospitals.

Anthem officials have said the main driver in selecting providers was geography — more than 90 percent of the plans’ potential customers live within 20 miles of a network hospital, though under the law, that distance could’ve been twice as far and still considered adequate.

Including all hospitals would have made it impossible to keep premiums low, Anthem president Lisa Guertin told lawmakers in September. Network hospitals agreed to reimbursement rate concessions in exchange for the promise of a certain volume of patients, she said. Without those concessions, premiums would about 30 percent higher, she said.

But Felgar argues that all hospitals should have been given an opportunity to participate. He cited a federal government report that compared what hospitals charge for a range of services and procedures and found that Frisbie charged less than its area competitors, and a separate study that gave it high marks on quality.

“I’m quite baffled why the low-cost provider, and a high-quality producer, is not even invited to sit down and negotiate with Anthem on this very important subject,” he said. “I want to know what’s going on. I want a chance to get in the game.”

While it’s unclear how much business Frisbie stands to lose, Felgar said it treats about 7,000 uninsured patients who would have to seek care elsewhere if they purchase insurance through the new marketplace. Many of them rely on public transportation to get to medical appointments, he said.

“We’re a working-class community,” he said. “This is going to be a hardship.”

Insurance Commissioner Roger Sevigny has said that the department’s authority is limited to deciding whether a network complies with the state’s network adequacy laws, and in this case, Anthem met the requirements.

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