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HealthBeat

N.H. Insurance Department hears arguments over Anthem’s narrow network

State Insurance Department officials yesterday defended their decision to recommend Anthem’s limited network for plans sold in the state through the Affordable Care Act, against a challenge from a Rochester woman who said the network could cost her a 15-year relationship with her doctor.

Anthem is the only insurance company selling plans this year on the exchange, the online marketplace created by the Affordable Care Act. The network for those plans excludes 10 of the state’s 26 hospitals, including Concord Hospital. Narrowing the network kept premium costs down between 25 and 30 percent, Anthem officials said.

But Margaret McCarthy, a semiretired bookkeeper, said Anthem excluding Frisbie Memorial Hospital and its affiliated physicians in the network for the plans caused her anxiety as she got different answers over several months about whether she’d be able to see her doctor under the new plan.

She renewed her plan, including the network with her current doctors, last summer and it expires in August. At that time, she’ll have to decide on a new plan; none are currently offered that include her doctors, though other insurance companies plan to begin selling plans effective January 1 that will.

But attorneys for the state’s Insurance Department said the standards for determining whether an insurance network is adequate require at least 90 percent of people in a county to be within 15 miles or 40 minutes of their primary care doctor.

Department officials based their review around prospective data, because they had to rule on the network before the plan was sold. According to that review, more than 90 percent of prospective enrollees in the plan lived within the coverage area, they said.

Insurance Commissioner Roger Sevigny will rule on the issue by the end of August.

If he decides that Anthem’s network is inadequate in Strafford County, the company will not be able to market it there. The department can also require Anthem submit a plan for corrective action.

McCarthy’s attorney, Jeremy Eggleton of Orr and Reno, tried to expand the discussion to coverage in other counties, but Sevigny sustained objections from the department and Anthem.

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

This article has been updated to correctly reflect McCarthy’s current insurance plan. She still has access to her doctors.

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