Anthem’s narrow network, N.H. insurance regulators criticized at hearing
Dr. James A. Betti, a surgeon who practices out of Frisbie Memorial Hospital and Portsmouth Regional Hospital walks down the aisle after speaking at a hearing held by the New Hampshire Insurance Department about Anthem's limited network for the Affordable Care Act on Monday, February 10. 2014. Neither Frisbie Memorial nor Portsmouth Regional are included in Anthem's limited network.
ARIANA van den AKKER / Monitor staff
The New Hampshire Insurance Department held a hearing Monday, February 10, 2013 about Anthem's limited network for the Affordable Care Act. More than two dozen people spoke at the hearing expressing their frustrations with the limited network and the lack of options for subsidized insurance. Currently Anthem is the only company in New Hampshire offering plans through the Affordable Care Act. Ten of New Hampshire's 26 hospitals are excluded from that plan.
ARIANA van den AKKER / Monitor staff
More than two dozen people, most from Rochester, excoriated state insurance officials yesterday for approving a network for the state’s federal health insurance exchange that excludes 10 of the state’s 26 hospitals, including theirs, Frisbie Memorial Hospital.
“The elephant in the room, . . . the reason why people are really mad, is they were promised by the president of the United States and our U.S. senators that this would not happen. They were told they could keep their health insurance, keep their hospital and keep their doctor, and it has not happened. There is a public trust that’s been violated, and frankly, they don’t believe you’re going to do anything about it,” Dr. James Betti of Frisbie Memorial Hospital told state regulators, to a standing ovation from the crowd.
Anthem Blue Cross Blue Shield is the only insurance company that applied to sell plans this year on the exchange, part of the federal Affordable Care Act. By crafting a narrow network, company representatives have said, they were able to keep premium costs lower.
Concord Hospital is also not on the network, because the payment rates offered were too low to ensure continued financial viability for the hospital, former CEO Mike Green has said.
Officials from Frisbie, Monadnock Community Hospital in Peterborough and Valley Regional Hospital in Claremont said yesterday they were not given any offer from Anthem, and they wanted the chance to at least negotiate.
Small businesses and individuals without employer-sponsored health insurance must use the exchange to access tax credits toward the cost of their insurance, in which case they’d be subject to Anthem’s narrow network.
That network was approved by federal officials last summer, after state regulators determined the network met state rules for how far patients would have to drive to access care by a provider on their plan.
More than 11,400 people in New Hampshire have bought insurance plans on the marketplace, including Michael Justice, a Peterborough resident, who said he won’t be able to continue seeing the doctors at Monadnock Community Hospital who saved his life after his heart attack six years ago.
“Our only viable option is the Anthem marketplace,” he said. “Despite promises from government officials, the plan cost us our doctors. The focus should be on all of us, our neighbors, families and fellow citizens whose health is or will become endangered.”
“This conversation should have occurred in June or July, when we could have had a say about your decision,” said Rochester Mayor Thomas Jean.
“People are being forced to sever their long-standing relationships with their doctors and their hospital,” Jean said. “It’s difficult for me to hear our citizens in such pain and despair. Really look at this closely. You do have an option. This was thrust on you unfairly, and you can thrust this back to Anthem. Make a decision to tell them to please engage with Frisbie and the other excluded hospitals.”
However, before the public spoke, and during a question-and-answer session after, Insurance Commissioner Roger Sevigny and other officials outlined the limitations of their department’s power.
When it comes to network adequacy, the department enforces state rules about driving distances, operating hours and waiting times, many of which were written in the 1990s.
State law also requires that details of insurance plans submitted as applications for approval – including forms, rates and networks – are kept confidential until the plan goes into effect.
But Sevigny told the crowd his department would soon convene a group of stakeholders to review the network adequacy rules and recommend changes to the Legislature, especially to the requirement that services are “accessible without unreasonable delay.”
“Fleshing out ‘reasonable’ better is high on the list of things this group will be looking at,” he said.
(Sarah Palermo can be reached at 369-3322 or email@example.com or on Twitter @SPalermoNews.)