Concord Hospital not part of provider network for Obamacare exchange plan in N.H.

Last modified: 9/10/2013 4:00:02 PM
Concord Hospital and its associated physician practices around the region – from Hillsboro to Epsom to Warner – will not be in the provider network for consumers who purchase insurance through the new marketplace authorized by the Affordable Care Act.

Anthem Blue Cross Blue Shield is the only insurer offering plans for sale on the marketplace, which is due to start enrolling people Oct. 1.

Individuals and businesses who purchase insurance through the marketplace, and individuals who purchase insurance through Anthem outside the marketplace, will be on the narrow network. In total, those plans will cover about 10 percent of people insured by the company next year, said Anthem President Lisa Guertin.

The network limitation does not affect employer-sponsored coverage not purchased on the exchange, according to Anthem.

By contracting with 16 of the 26 acute general care hospitals in the state, Anthem was able to keep premium costs 25 percent lower than they would be if all hospitals in the state were part of the network, according to a statement from the insurer yesterday.

Anthem did not release the rates yesterday but they are expected to become public later this month after federal officials review the proposal.

Concord Hospital was invited to join the network, but declined because Anthem “did not offer us anything that we considered reasonable,” said CEO Mike Green. “They were substantially below what they offer in their other plans and would have been hard for us to break even using those rates.”

“There was no comparison” between the rates proposed and the rates Anthem pays for other patients, he said. “It was unreasonable from our perspective. We’re always open to negotiations (but) they never came back to the table.”

“Concord remains a really important partner for us in providing care,” Guertin said. And while “we don’t talk about specific rates or specific discussions . . . we believe we offered a very reasonable rate, and 17 hospitals clearly agreed.”

She was including a Burlington, Mass., hospital in her count.

LRGHealthcare, which includes Lakes Region General Hospital in Laconia and Franklin Regional Hospital, is part of the network. So are New London Hospital and Mary Hitchcock Memorial Hospital in Lebanon.

On Wednesday, Anthem officials said that neither Androscoggin Valley Hospital in Berlin nor Littleton Hospital was part of the network, which would have left all of Coos County without access to maternity care, because Weeks Medical Center in Lancaster, while part of the network, does not provide that service.

As of yesterday, both Androscoggin and Littleton were on a list of network providers.

“I don’t think there was a gap,” Guertin said yesterday after the revised network was announced. “I think we applied an abundance of caution, and our network already exceeded network adequacy across the board. This was a unique situation in terms of the specialty we were talking about and the geography involved. We concluded that it would be a better offering if we could get a couple of those facilities in.”

Cheshire Medical Center in Keene is the only hospital west of Nashua and south of Lebanon on the plan.

Other states are also dealing with the not-so-new world of narrow networks. Maine’s health insurance marketplace includes a plan that excludes hundreds of doctors from six hospitals in the southern part of the state.

Nearly half the exchange plans in 13 states with early filings will be considered narrow networks, according to an article last month in the industry publication Modern Healthcare.

Republicans in the state Legislature used the situation to attack the federal health care reform law in general and Democrats in particular.

Rep. John Hunt, a Republican from Rindge who co-chairs the committee overseeing the implementation of the marketplace, said the issue shows the federal health care reform law is “counter-productive.”

“The blunt point is, this mess was created by the Affordable Care Act. In the efforts to give people subsidized health insurance, we are going to disrupt the health marketplace and disrupt the people who had health insurance. . . . Before, price was a barrier to health care, and now the barrier is going to be finding a provider in the network, and how far away you have to go to get to them,” he said.

A spokesman for Gov. Maggie Hassan, a Democrat, issued a statement yesterday, saying “Gov. Hassan will continue to stand up for the health and well-being of the people of New Hampshire by putting ideology and politics aside and working constructively with all parties to improve the quality and affordability of health coverage in the state. We hope others will do the same.”

The state Department of Insurance approved the proposal last month and sent it to federal regulators, who could rule next week on some aspects.

Republicans this week also criticized the governor and the department for not releasing information about the proposed network sooner, but a state law, which was passed after a period of regulatory gridlock when insurers repeatedly revised their plans to be more competitive, protects proprietary information like provider networks and rates.



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




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