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Concord Hospital not part of provider network for Obamacare exchange plan in N.H.

  • Concord Hospital campus, Pleasant View, lower right.<br/><br/>Dan Habib Photo

    Concord Hospital campus, Pleasant View, lower right.

    Dan Habib Photo

  • Concord Hospital campus, Pleasant View, lower right.<br/><br/>Dan Habib Photo

Concord Hospital and its associated physician practices around the region – from Hillsboro to Epsom to Warner – will not be in the provider network for consumers who purchase insurance through the new marketplace authorized by the Affordable Care Act.

Anthem Blue Cross Blue Shield is the only insurer offering plans for sale on the marketplace, which is due to start enrolling people Oct. 1.

Individuals and businesses who purchase insurance through the marketplace, and individuals who purchase insurance through Anthem outside the marketplace, will be on the narrow network. In total, those plans will cover about 10 percent of people insured by the company next year, said Anthem President Lisa Guertin.

The network limitation does not affect employer-sponsored coverage not purchased on the exchange, according to Anthem.

By contracting with 16 of the 26 acute general care hospitals in the state, Anthem was able to keep premium costs 25 percent lower than they would be if all hospitals in the state were part of the network, according to a statement from the insurer yesterday.

Anthem did not release the rates yesterday but they are expected to become public later this month after federal officials review the proposal.

Concord Hospital was invited to join the network, but declined because Anthem “did not offer us anything that we considered reasonable,” said CEO Mike Green. “They were substantially below what they offer in their other plans and would have been hard for us to break even using those rates.”

“There was no comparison” between the rates proposed and the rates Anthem pays for other patients, he said. “It was unreasonable from our perspective. We’re always open to negotiations (but) they never came back to the table.”

“Concord remains a really important partner for us in providing care,” Guertin said. And while “we don’t talk about specific rates or specific discussions . . . we believe we offered a very reasonable rate, and 17 hospitals clearly agreed.”

She was including a Burlington, Mass., hospital in her count.

LRGHealthcare, which includes Lakes Region General Hospital in Laconia and Franklin Regional Hospital, is part of the network. So are New London Hospital and Mary Hitchcock Memorial Hospital in Lebanon.

On Wednesday, Anthem officials said that neither Androscoggin Valley Hospital in Berlin nor Littleton Hospital was part of the network, which would have left all of Coos County without access to maternity care, because Weeks Medical Center in Lancaster, while part of the network, does not provide that service.

As of yesterday, both Androscoggin and Littleton were on a list of network providers.

“I don’t think there was a gap,” Guertin said yesterday after the revised network was announced. “I think we applied an abundance of caution, and our network already exceeded network adequacy across the board. This was a unique situation in terms of the specialty we were talking about and the geography involved. We concluded that it would be a better offering if we could get a couple of those facilities in.”

Cheshire Medical Center in Keene is the only hospital west of Nashua and south of Lebanon on the plan.

Other states are also dealing with the not-so-new world of narrow networks. Maine’s health insurance marketplace includes a plan that excludes hundreds of doctors from six hospitals in the southern part of the state.

Nearly half the exchange plans in 13 states with early filings will be considered narrow networks, according to an article last month in the industry publication Modern Healthcare.

Republicans in the state Legislature used the situation to attack the federal health care reform law in general and Democrats in particular.

Rep. John Hunt, a Republican from Rindge who co-chairs the committee overseeing the implementation of the marketplace, said the issue shows the federal health care reform law is “counter-productive.”

“The blunt point is, this mess was created by the Affordable Care Act. In the efforts to give people subsidized health insurance, we are going to disrupt the health marketplace and disrupt the people who had health insurance. . . . Before, price was a barrier to health care, and now the barrier is going to be finding a provider in the network, and how far away you have to go to get to them,” he said.

A spokesman for Gov. Maggie Hassan, a Democrat, issued a statement yesterday, saying “Gov. Hassan will continue to stand up for the health and well-being of the people of New Hampshire by putting ideology and politics aside and working constructively with all parties to improve the quality and affordability of health coverage in the state. We hope others will do the same.”

The state Department of Insurance approved the proposal last month and sent it to federal regulators, who could rule next week on some aspects.

Republicans this week also criticized the governor and the department for not releasing information about the proposed network sooner, but a state law, which was passed after a period of regulatory gridlock when insurers repeatedly revised their plans to be more competitive, protects proprietary information like provider networks and rates.

(Sarah Palermo can be reached at 369-3322 or
spalermo@cmonitor.com or on Twitter @SPalermoNews.)

CONCORD HOSPITAL NOT IN THE NETWORK?!?!?!? What are there, like 26 hospitals in NH??? Concord Hospital has to be one of the biggest. This is surprising, and crappy news for residents of the greater Concord area.

why did NH have only one provider

Vermont like MA, CA, RI, CT and Maine are not states we want to emulate. Vermont has a very high tax burden on it's residents. Number 13 in the nation. NH is #43. Vermont cannot manage even with all it's taxes to keep costs down for health care, education or anything for that matter. So the idea that having more taxes works is a fallacy. Vermont's property taxes are not that much cheaper than NH. And VT just got the number one Moocher Award for folks who are on govt programs that are not poor.

22 states have not set up a network and 4 more are still mulling it over. So NH is not alone in this. You can also thank the Supremes for doing what they usually do. They leave it up to the states!

100% of the ObamaKare disaster is brought to you 100% by the democrats. Not a single Republican voted for it. Remember Hillary voted for this Train Wreck too.

One wonders how many business owners would be willing to accept reimbursement from the govt for the products and services they offer. Would a store be willing to accept 60% cost for food? yet we expect Doctors to accept that. Another factor that is not talked about is the paperwork involved. I went for my annual checkup and my Doc had to ask me a list of questions mandated by the ACA. Asked me if my husband abused me, if we had a gun in the house and if anybody in my home. suffered depression. He apologized for the questions and told me the time he use to spend on patient interaction was now being taken over by paperwork. He was not happy. Said he could not see as many patients because of this, and felt the doctor patient relationship was being ruined. He also said that he knows many doctors that are retiring early.

This is a frightening turn of events. I feel that soon the right of choice will be taken away from many. Not only should the government not be involved but the medical community is govern by greed.....

Note the picture. To the right, behind the hospital are the homes of the oh----so----- enlightened elite of Concord, most of which are supporters of Obamacare and the mess that will ensue if we allow it to be implemented and don't stop it in Congress.

Interesting comment from one always ready in other contexts to defend the rich and their excesses as just desserts. So the 'enlightened elite' must be what, "traitors to their class"?

I read on here the following comment: "I've got mine, screw you" about supposed conservatives who don't want to pay the freight for other people. The same could be said for those nob hill folks who can afford the huge increases of Obamacare and just want it because it meets their sense of "fairness". And, I don't defend the rich and their "choices" (not excesses), I just don't think it is any of my business so long as they make their wealth through hard work, personal sacrifice and choices and following existing law. It is a small person who envies the other person for what they have accomplished and done while not reflecting on his/her own choices and taking responsibility for their own outcome; petty jealousy and denial of the reasons for outcome shows low self respect.

Concord and nearby Hopkinton are home to a massive amount of limousine liberals

I have not misread anything FOF and Bruce. Grandfathered plans is the term which means that if you already have a plan prior to the passing of the ACA in 2010 you can keep that plan as long as that plan qualifies by the rules under the ACA of what is an acceptable plan, otherwise your plan loses it's grandfathered status. That means that an employee cannot change his health plan for many reasons like lower costs, employee contribution and a host of other rules in the ACA which means that most health plans will lose their grandfathered status. Latest stats are that 75% of health plans will lose that grandfathered status because they do not meet the ACA requirements. Look what Anthem is doing in Maine. That is what they will do in NH. They cannot offer you the old plans. You have to take on their ACA approved plans and that means a narrower network of who will accept Anthem.

The bigger story here is Obamacare. I have first hand dealings with what Obamacare will do to the overall health care, the insurance premiums, deductibles and drug prices once it is fully in place. Looking forward to 2015 (conveniently pushed back for the 2014 election snow job), the employer mandate will have the following impact on my economic picture. My $360 per month employer paid health insurance will become $610 or it will increase $250 more each month or $3000 more per year. My deductible will increase from $600 to $1500. Now add that in and it will cost me $3900 more. Drugs will increase on my plan by $1000. So, based on a family plan for 4, the household will pay 5.6% more out of the household income for less and have to wait in line along with those who we are subsidizing. Hardly affordable. My 22 year old could go on my plan for an extra $250 per month or she can pay for mandatory health insurance to the tune of $200 per month. A recent graduate, she will have $220 mandatory insurance plus her $400 student loan payment plus $600 rent, $200 utilities and $200 groceries. He gross income is $30,000 and net pay will barely cover her bills. Obamacare will be 8% of her gross income. Let's be honest folks, some progressives want to subsidize their health insurance, some progressives want "fairness" and others just want to make it difficult on others so that people will buckle to 'single payer', which would, be even worse. Obamacare is just another tax and a redistributionist scheme. It is not "affordable".

If your daughter was on your plan while in school, then there should be no increase in cost to the insurance company for her continued coverage to age 26. If the cost is going up, that's an issue that needs to be looked at more closely by policy holders/employers and state insurance regulators. Also, your daughter will probably be eligible for a tax credit if she buys insurance through the exchange. http://kff.org/interactive/subsidy-calculator/

The cost is going up because it is simply more expensive for employers to meet the mandates of the bill. Not to mention that there is a $60,000 "tax" for the employers right offer insurance under Obamacare. Now, my employer is going to have to pay 2.5X for less insurance coverage to meet the mandates, they do pay 75% of the cost of premiums but premiums are still going up. It is NOT affordable. The stories in the press that claim coverage is not going up are stories about the cost of those who do not receive employer based insurance. Yes, a person now self insured for $15,000 for a family of four will now pay less but that is not what the bill was supposed to be about. My close friends company decided it was cheaper to not offer insurance and they will be dropping it and taking the fine in 2015. Another friend of mine was told that in 2015 it will double as the company will pay even less as a result. A company with 1000 full and part time employees to keep their current level of coverage at $1 million per year will approximately $2.3 million per year and about $70,000 in "taxes" for the right to offer healthcare which they already offer. My student was covered under college health care and to add her costs even more now. My point is that if this is affordable, why is it costing families between $2000 and $4000 more per year? The short answer is that they are now paying for their family and other people too. It is not fair.

Oh come on now....we all know our federal government can't seem to run any agency efficiently. Why would this be any different? I can't wait until the IRS has my medical records (if they don't already) because we all know how compassionate and respectful they are.

Our current health care system, dominated by "for profit" insurers and institutions, is far from 'efficient'. By most measures of effectiveness and cost, the U.S. healthcare system ranks far below those of many other nations. We pay much more for healthcare as a % of GDP than most other developed nations, and often have poorer outcomes.

That's right, people are coming here from all over the world and Canada to receive a poorer outcome. What really irks you is "for profit". Well we still live in a capitalist economy, not a socialist or communist country.

As usual, many of your claims are based on distorted and inaccurate information. People are not flocking "from all over the world and Canada for their health care." And if you are truly concerned about health care costs, then you should be supporting more changes in the way we provide health care in this country, beyond just thanking unions past and present for the fact you have employer-based health insurance. To the extent that "for profit" practices increase costs without improving delivery of services, then we can do better with a different model--the way most other advanced nations do. BTW: our economy is more aptly described as a "mixed economy". Wherever "laissez-faire" capitalism has been tried, it's been found wanting. No where is that more true than with health care. "The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered. Myth: The Canadian system is significantly more expensive than that of the U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services. Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs. Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is."http://www.denverpost.com/opinion/ci_12523427

No, Itsa, this Canadians and others flocking here for our superior health care is a bogus claim. Most are Canadians who happen to be vacationing or temporarily working here. The rest are wealthy Canadians who have bought into the lie or who want "gold-plated" care.

Well, it depends how you measure it. The United States healthcare is amongst the best on timely delivery. But what you are quoting is the World Health Organization assessment of health care. They measured five factors. Life expectancy depends on much more than the health care system, it depends on genetics, diet, air quality, etc. On responsiveness, the U.S. is one of the best but WHO only rated that at 12.5% as a factor. They rated financial fairness as 25% but that is weighted to offer cheaper care, which, is not a measure of overall quality. They also rated health distribution or equal distribution of health care at 25% and obviously "equal" means that limited dollars would be rationed. We don't have single payer so that is irrelevant. Finally, they measured responsiveness as part of the exact equal distribution of health care at 12.5% and honestly that is pretty political and ideological. In 2008, about 90% of the population had insurance and most of those people were happy with it. To throw away everyone's insurance so that 10% can have "equal" care and raise the cost as well as lower the quality for that 90% is truly wrong. Period.

I will not be shocked if Anthem's narrow network gets wider in the near future.

Obama-"you can keep your doctor" is a liar. Jeanne Shaheen, liberal rubber stamp we must fire. NH please smarten up and get rid of Jeanne Shaheen in November of 2014.

OK, Van. Pay attention. First off, this was a decision by Anthem, which is not connected to or run by the president. Second, no one is losing his or her doctor. This relates only to a new insurance network which has not even started up yet, and people who have insurance, and have a doctor, are unlikely to be affected by this. Third, it's a bit unfair for you to have cheered on the folks in the last NH legislature when they threw every possible roadblock in the way of implementation of the ACA and now to point the finger at the president when the impact of those roadblocks comes to light. Vermont, by contrast, seems to be doing just fine with their implementation of the ACA. But they didn't have your heroes in their legislature.

Not rocket science here folks. Anthem is narrowing their network to make a profit. And they have not posted yet the cost of these plans or the coverage. So basically if you have Anthem you will have to switch doctors that are affiliated with a hospital on Anthem's network. And you will most likely have to travel to get that care. My guess is that a lot of folks will not buy Anthem Insurance. And most likely those that already have it will dump it for another insurance. That will mean the folks that do buy it will see their rates increase because of low participation in the plans. Once the costs and coverage are revealed, my guess is that Anthem will be offering expensive plans with coverage that is not great. Check out the recent costs in Vermont. The costs are very high, especially for low level incomes. This is a mess. The ACA will fail because it is a very bad law filled with taxes, limited networks, and a host of other issues.

No - that's not correct, Rabbit. If you already have Anthem, through an employer or an individual plan, nothing changes for you. The only people affected by this are those who purchase a plan through the exchange when it starts up next year. There will be no mass exodus from Anthem because of this decision.

Not so. You have misread this article. You will not have to switch doctors if you already have Anthem/Blue Cross. This article refers only to the new health exchanges being set up for people without employer-provided insurance, or without health insurance of any kind, or those who wish to obtain more affordable coverage. http://blogs.wsj.com/corporate-intelligence/2013/07/14/how-will-health-insurance-exchanges-work/

To RabbitNH, Bruce_Currie and Field-of-Ferns, You're all almost right. Third paragraph: The changes will affect three groups: "individuals and businesses who purchase insurance through the marketplace, and individuals who purchase insurance through Anthem outside the marketplace."

Well done Article Sarah. Good balance and informative. You can't ask for more as a CM reader. Thanks Van

Publius, sorry I am not a low information voter that you can confuse and con. Thanks to the consequences of ObamaKare people will be losing their Doctors. This is a big reason why Obama wants to push the employer mandate after the 2014 election. Perhaps you can con the low information voter but people are finding out and they don't like it and ObamaKare supporter Shaheen will pay the price.

Well, you may have lots of information, but what is not inaccurate you seem to misinterpret. In your comment above, when you're not trumpeting your vast store of knowledge, you are speculating about things that may - or may not - happen in the future. I suggest that you give a look at the following article, in which Dr. James Weinstein, CEO of Dartmouth Hitchcock, describes the differences between Vermont and New Hampshire when it comes to implementation of the new healthcare system. He is both a MD and healthcare executive who does business in both VT and NH, so he is speaking from a knowledge base significantly different, and likely more reliable than yours. http://www.vnews.com/news/dartmouth/8352150-95/d-h-ceo-nh-lags-behind-vt

Understanding the difference between VT and NH. VT, a state who has elected a socialist to the US Senate over and over again. I will pass on your waste of time reading.

Van, it's an interesting take on Publius' link, for one who constantly rails against so-called "low-information voters", to blithely dismiss it as "waste of time reading". In any case, we have an interesting experiment running between 2 states, one of which is actively preparing for the ACA, and the other doing as little as possible. Time will tell which state was the wiser.

Reply to your reply below. So you would intentionally keep yourself ignorant. We all now know the basis of your comments - and I now will simply ignore you because you have nothing to offer. How sad.

That is correct, Van. If Concord Hospital is not participating in the exchange and you use one of the Concord Hospital providers, you will indeed lose your doctor. You are also, absolutely correct about the politics of why Obama wants to push the employer mandate back. It is all politics and a failed piece of legislation.

I always suspected CH is overpriced and in it for the money. Now I know.

So now concord hospital is at fault for the ObamaKare Train wreck. When are the democrats going to grow up and take responsibility for their actions?

CH's decision to not be part of the Anthem network was monetary--as in not enough. Apparently 16 other hospitals did not agree.

Because someone does not march in lockstep to Obamacare and the train wreck that it is does not mean that people are in healthcare "for the money" or that a hospital is "overpriced". In fact, the two surgeries I have had at Concord Hospital were cheaper than what other hospitals would charge. Here is a handy tool which will give you actual costs between hospitals. http://www.healthcarebluebook.com/ .

Apparently Ducklady you think Doctors should work for a loss. I think the Concord Hospital System is fantastic and I will continue to go there because I do not have ObamaKare.

Exactly Van, would a CPA offer services for free so that everyone had equal benefit of his/her services? Do lawyers do that? And lawyers are the biggest opportunists and money suckers in all of society. At least hospitals provide a good service.

Hay, Van, I thought you respected the Concord Hospital. Apparently not, since you choose not to capitalize its name just as you do "democrat." What do they have to do to earn your respect and upper case initial letters like the Republicans? Gawd, you are so transparent!

I respect Concord Hospital and honestly, I do understand why people spell Obamacare.....ObamaKare. It is referring to the Soviet style bullying of this administration and how the Draconian ACA was passed by a Congress that is now no longer. It was sneaky and very dirty the way it was passed. It was a pollitical bill....if you get my drift.....what democrats have to do is be honest. No longer is there any debate of issues, just policy statements that one side is right and one is wrong.

Republican dream--stall the exchange, prevent competition, delay participation, increase the hardship to patients.

Agreed as far as you went, but you left out the final element - the Republicans now blame Mr. Obama and the Democrats for the harm they themselves have caused.

Facts please - ( from a reputable source of course )

This post get my vote for "Most unintentionally ironic comment of the week".

Oh, stop it, you two! You'll get somebody's (Van, sail, itsa, GWTW?) panties in a bunch.

Sail was asking for a reputable source, not Mother Jones or Salon.com.

Publius, lets present some facts or we will all know your words are just a con job. What harm have the Republicans caused? Facts please.

OK, Mr. Well-Informed, we can start with hb1297 (2012) that the previous Republican-led legislature enacted to prevent NH from forming an exchange on our own. If you remember correctly, before that vote, NH was ahead of the curve in its preparation for the ACA, but the Rs in the house put a stop to those preparations. Now NH is scrambling to catch up. Then this year, the Republican-led Senate voted down hb668, which was designed to allow the Insurance Dep't to bring NH's insurance regs into line with the ACA. And, of course, there is the action to delay the expansion of Medicaid. For starters. And that's just in NH. I won't even get into all the talk about shutting down the federal gov't unless Mr. Obama caves on the ACA. All these roadblocks have been thrown up by the Republicans to delay or derail progress in implementation of the ACA. It's a bit unfair to hinder, delay and obstruct and then point to others and say it's all their fault.

If the government is "shut down", it will happen because Obama will want to make cuts other than Obamacare and politically will make the choice to cause as much pain as he can as he did with the sequester. If Congress defunds Obamacare, then, that should be the program which is not funded. Period.

No stalling here Veritas. I believe that we are seeing what is going on here. Many are realizing what a bad plan the ACA is. That is a fact that the left refuse to accept. They refuse to acknowledge the cost, taxes, etc and now folks and companies are getting informed. Simple as that. Why do you think the insurance companies are not standing in line to get in on this? This article about Anthem shows you why. In order for the insurance company to make a profit they have to do what Anthem is doing. If you do not know how things work and trust the politicians, this is what you end up with. And now we have allowed those politicians to mess up our health care.

Sooo... let's take the profit motive out of the insurance game and go with single-payor, or that "public option" that was shot down so early in the game.

Sooo.....that was the end game by Democrats. Frustrate the populace with this boondoggle and then offer "public option" or "single payor" which translates into government control of your health and your longevity and your treatment when you need it most late in life. People are the government........not progressives. You can't always have it all your way you know.

OBAMAKARE LAW: NO INSURANCE COMPANY CAN MAKE MORE THAN 15% PROFIT

Rabbit, do you really want an answer to this question: "Why do you think the insurance companies are not standing in line to get in on this?" In case you really do which I don't believe for a second, the answer is GREED. And that's been true ever since finance capitalism took over (circa 1980) and taught businesses that the only thing they needed to make was a profit.

Blaming Republicans for all things is so 2009. People are waking up to the ObamaKare Train Wreck and you are not going to like the consequences.

Van, until you decide to spell it Obamacare as an adult would, why should anybody beyond your circle take your comments for anything but wind?

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