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Maine co-op network includes some N.H. hospitals

Margaret McCarthy lives so close to Frisbie Memorial Hospital, a recent blood test appointment took 15 minutes, including travel time.

But the Rochester hospital isn’t included in the only provider network available to New Hampshire residents buying health insurance through the new government marketplace. And while the thought of going elsewhere is enough to make McCarthy’s blood boil, she’s also angry that, in an ironic twist, most Maine residents who buy marketplace plans can use a handful of New Hampshire hospitals, including the one 4 miles from her home.

“Somebody needs to get on the stick and see that the people of New Hampshire have more choices,” she said.

In both Maine and New Hampshire, Anthem Blue Cross Blue Shield is the only for-profit insurance company offering health plans through the new marketplace, and it has faced criticism in both states for excluding some hospitals from its networks. But Maine’s marketplace also offers plans from Maine Community Health Options, a nonprofit cooperative that has contracted with four New Hampshire hospitals: Frisbie, Portsmouth Regional Hospital, Wentworth-Douglass Hospital in Dover and Memorial Hospital in North Conway. Like Frisbie, the Portsmouth hospital is not included in Anthem’s network.

Kevin Lewis, the co-op’s chief executive officer, said that in crafting its network, MCHO wanted to ensure that access to coverage equals access to care. For Maine customers who live near the border, visiting a hospital in New Hampshire may make the most sense, he said.

“People that live along the border and work in New Hampshire, or some people that live in New Hampshire and work for companies in Maine, we want to make sure that they’re not disadvantaged and have the full range of access to care that we provide elsewhere to the state of Maine,” he said.

MCHO customers also have access to a national provider network administered by First Health, and its broad network may be contributing to its success in drawing significantly more customers than Anthem in Maine. About 80 percent of the roughly 20,500 Mainers who have signed up for coverage on the exchange through January have picked MCHO plans, Lewis said.

In New Hampshire, Anthem is the only option, though two other companies, including a cooperative, have said they will enter the market next year. McCarthy purchased her Anthem plan outside the marketplace, before the new network was created, and can keep it until it expires in August. Then, she’ll have to decide whether to purchase a new Anthem plan and find new doctors or “cross my fingers and hope something changes” for 2015.

McCarthy and many others who spoke at a New Hampshire Insurance Department hearing last week said Anthem should be required to negotiate with any willing provider, but it’s not that simple. 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. If Frisbie was in the network, for example, Wentworth-Douglass Hospital in neighboring Dover might not see the same volume of patients.

The narrow-network debate has touched Maine, too, where the state Bureau of Insurance denied Anthem’s proposal to move customers in southern Maine into plans that exclude some hospitals but approved it in the northern part of the state.

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