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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.

Legacy Comments10

Well Veritas, your post just repeats the myth that you have been sold by your party. No mention from you why Anthem decide to keep their network narrow. That was deliberate by the way. The only thing that is getting old here, is the fact that many on the left have no clue what is in the ACA. That is why they use excuses and repeat the same mantra. Even if that mantra is false. Not sure why folks want to stay uninformed, the only reason I can imagine they want to is to promote their agenda while ignoring what that agenda will do to jobs, the economy, and the quality of health care in this country. But I guess if you need big govt to take care of all your needs, then basically you have no concept of the economy, how jobs are created and how to manage your life. Big govt is a religion. Offers the same deal. Believe and you will be rewarded. Funny too, because the left are anti religion, yet they worship at the altar of big govt.

The only thing getting old here is your posts.

GREAT POST rabbit !

Kiss, kiss, kiss, Rabbit, GWTW, ITSA, We all love each other and just completely agree on EVERYTHING!

Now that is being a troll and the third time in a week. I had no post here to comment on. You bring my name into comments like yours above just to stir things up. I am not interested. But I wanted you to know that I am on to your game. Thanks but no thanks.

If it was a good game I would play along but what the extreme left does in this forum is simply juvenile

Winning elections and party ideology is now more important than actually accomplishing good things for the general public.

What is best for the general public is for government to get the Hell out of the way of individual freedom and NO, Obamacare is not "good for the general public"

IF Republicans had not prevented the development of a NH Exchange, there would have been more competition, and Anthem would not be alone in the market. Typical Republican methodology -- exploit a problem, create a crisis, prevent a solution, and blame Obama. It's getting a little tired, guys.

"if you like your doctor...you can keep your doctor...if you like you plan you can keep your plan" IF...lol...or pay more. The Obama media, this newspaper included in that....did a heck of a job exposing that lie. Way to go.

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