NH hospital denied formal hearing on ACA network

CONCORD, N.H. (AP) — A New Hampshire hospital won’t get a formal hearing on its exclusion from the provider network for those purchasing individual insurance plans under the federal health care overhaul.

Frisbie Memorial Hospital in Rochester is fighting its exclusion from the new network created by Anthem Blue Cross and Blue Shield of New Hampshire, the only company offering health insurance plans in the new markets required under President Barack Obama’s law. The network includes 74 percent of the state’s primary care providers, 85 percent of specialists and 16 of the state’s 26 acute-care hospitals.

Frisbie petitioned the state insurance department for a hearing and asked it to order Anthem to include it in the network. In an order posted late Wednesday, Insurance Commissioner Roger Sevigny said he will hold an informational public hearing in January on how it evaluates network adequacy, but the hospital won’t get a more formal adjudicative hearing. He said it was Anthem’s contracting decision that could harm the hospital, not the insurance department’s determination that the network met adequacy standards, and said even if the department reversed its determination, it couldn’t order Anthem to contract with Frisbie.

“It would serve no purpose, and waste both agency and judicial resources, to allow an appeal of an agency decision when the agency does not have the power to grant the requested relief,” he wrote.

Al Felgar, Frisbie’s president and CEO, said he was pleased that there will be a public hearing and while disappointed about the formal hearing, understands the department’s reasoning. But, he said, the order ignores the harm the network will cause.

“There is no mistaking and no disputing the serious damage that will come to existing relationship between physicians at Frisbie and the thousands of patients they serve in greater Rochester, all because of Anthem’s decision to exclude Frisbie from its narrow network,” said Felgar, who also pushed the department to release all documents related to Anthem’s decision.

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. They said including all hospitals would have driven up premiums, because network hospitals agreed to reimbursement rate concessions in exchange for the promise of a certain volume of patients.

While Anthem is the only company offering health plans for 2014, others are likely to participate in future years. Harvard Pilgrim has indicated it will offer plans for coverage starting in 2015, and U.S. Rep. Carol Shea-Porter announced Thursday that nonprofit Minuteman Health of Massachusetts has been given federal approval to expand into New Hampshire and form a new program that will offer plans under the law.

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