New Hampshire Views: State must reverse approval of Anthem network
It’s hard to admit you screwed up, that you got it wrong.
So we understand the New Hampshire Insurance Department’s reluctance to admit wrongdoing in allowing Anthem Blue Cross Blue Shield to exclude 10 of the state’s 26 acute-care hospitals from the insurer’s health care plans offered on the “Marketplace” exchange under the Affordable Care Act.
But now state officials have a chance to eat crow, and do it gracefully.
On Wednesday at 10 a.m., Commissioner Roger Sevigny will preside over a hearing during which Margaret McCarthy will challenge the narrow network offered by Anthem and approved by Sevigny’s department.
McCarthy is a patient of doctors at Frisbie Memorial Hospital in Rochester, which has been shut out by Anthem. She is one of potentially 7,000 Frisbie clients who may be uprooted in order to be serviced under provisions of the Affordable Care Act.
When McCarthy’s current coverage expires later this year, she will have to change medical providers as a result of enrolling in an Anthem plan. Or she can keep her existing doctors and pay more for insurance. That is because she would have to forgo federal subsidies, unavailable if she bought a plan through the state exchange under the ACA.
Sevigny had earlier denied Frisbie’s request for a hearing on the merits of his department’s decision to cede up to 10 percent of the hospital’s client base to other facilities. Frisbie officials and McCarthy were told neither had standing to challenge the approval of Anthem’s health plans.
However, late last week Sevigny recanted – in part. He stuck to his earlier decision that Frisbie has no standing, noting “the network adequacy standards do not require that an insurance carrier contract with any particular medical provider, or that any particular enrolled participant have access to any particular provider.”
But Sevigny did an about-face on McCarthy, deciding she has standing “as a consumer who claims to have been harmed by the circumstance that there is only one Marketplace provider and that this provider has an inadequate network which can only be made adequate by the inclusion of Frisbie.”
Sevigny wrote that his decision “rests on the fact that Anthem is the only carrier offering plans in the marketplace, and that buying a marketplace plan is the only way to access federal subsidies.”
Our hope is that through the hearing process both McCarthy and Frisbie will get satisfaction.
Sevigny should never have negotiated away part of Frisbie’s client base. But more importantly, the Insurance Department erred in forcing Granite Staters to change doctors, change hospitals and in many cases travel miles away from home to receive treatment.
Frisbie is only one of 10 hospitals arbitrarily excluded by Anthem. And while Frisbie clients are now faced with difficult and expensive choices, those elsewhere in the state are facing worse fates – especially in the North Country’s nether regions where health care providers have been scarce from the get-go.
On Wednesday, the facts should speak loud and clear on behalf of McCarthy and others.
The approval of Anthem’s exclusionary network must be overturned.
Anthem and hospitals like Frisbie should be ordered to the negotiating table so that all eligible Granite Staters can be adequately served by the ACA’s health care exchange.