NH holds public hearing on provider network rules

NH insurance department holds public hearing on standards for provider networks

Associated Press

CONCORD, N.H. (AP) -- Doctors, patients and hospital officials urged the New Hampshire insurance commissioner Monday to give all willing providers a chance to negotiate with the only company offering individual health insurance through the federal health care overhaul law.

"You do have an option. This was thrust on you, I think unfairly, but equally, you can thrust this back on Anthem," Rochester Mayor T.J. Jean said at a public hearing requested by Frisbie Memorial Hospital, one of 10 hospitals excluded from Anthem Blue Cross and Blue Shield's new provider network for individual plans.

According to Anthem and the insurance department, the network — which includes 16 hospitals, 78 percent of the state's primary care providers and 87 percent of specialists — meets or exceeds all state adequacy standards. Anthem officials have said that 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. Frisbie officials counter that they would have been willing to accept low reimbursement rates but weren't even given a chance to negotiate.

Insurance Commissioner Roger Sevigny did not immediately respond to requests that he order Anthem to negotiate with Frisbie and others. He said he would convene a working group to analyze the state's network adequacy standards and make recommendations to the Legislature.

While the insurance department can't force Anthem to contract with any particular provider, critics of the narrow network argued it could order the various parties to negotiate with each other. Many in the audience stood and applauded after Rochester surgeon Dr. James Betti told insurance department officials, "You guys need to step up."

"You're the only people who can do something about it," he said. "We ought to have full disclosure. We ought to have transparency. We ought to know what happens behind closed doors. ... We're paying for it."

Jeremy Eggleton, the hospital's lawyer, argued that the department didn't get the information necessary to fully evaluate the proposed network, and if it had, it wouldn't have approved it. He suggested Anthem was motivated more by money than by a desire to create an adequate network given that some of the largest coverage gaps line up with poorer areas of the state.

"For Anthem, these individuals with chronic health problems who previously haven't had insurance are the most likely to be the most burdensome economically, and they are the furthest from the health care they're going to end up needing," he said. "Patients that pose the greatest financial cost to Anthem are those that, through the creation of this network, are placed the furthest from the services they have access to."

Many of the more than 30 people who spoke at the hearing complained about Anthem's effective monopoly and the state's lack of insurance industry competition. At least two other insurers are expected to begin offering plans through the new marketplace for next year, but that was little consolation to those faced with finding new doctors or hospitals now.

Lisa Stanley said she decided to purchase coverage for her employees through the marketplace because it was the most affordable option and it allowed her to keep her small business tax credit. She figured they would "bite the bullet" and get new doctors for a year, and hope that things change for the better later. But she's since been told she needs to get a biopsy based on the results of a recent mammogram, and can't schedule one because she has no primary care physician to give her a referral.

"I would sure appreciate some continuity of care in my personal situation," she said.

The narrow network also applies to those buying individual plans from Anthem outside the marketplace, though existing policy holders had a chance to renew their plans for an additional year and keep the previous, broader network.

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