Some Anthem customers face higher premiums and must find new doctors

Last modified: 9/27/2013 11:58:04 AM
Holly Ares Snyder and Josh Kattef have a message for insurance companies: If you’re selling, they’re buying any plan that would let them keep seeing their doctors at Concord Hospital.

Roughly 40,000 New Hampshire residents purchase insurance plans on their own, almost all of them Anthem Blue Cross Blue Shield customers.

Snyder, who lives in Concord, and Kattef, who lives in Hopkinton, use Concord Hospital, which will not be in Anthem’s network for individual plans next year.

“My hope at this point is that some other insurance companies will step up to the plate,” Snyder said. “If there are other options, I certainly will be voting with my dollars.”

Anthem built the so-called narrow network in an effort to keep costs down for the plans it will sell on the new state insurance marketplace starting Tuesday.

In New Hampshire, about 170,000 people don’t have health insurance. The marketplace is supposed to be the way many get covered – the main goal of President Obama’s Affordable Care Act, also known as Obamacare.

As many as 65,000 people could use the New Hampshire marketplace next year – mostly self-employed or part-time workers who will purchase plans without employer support.

Though Harvard Pilgrim Health Care has said it will join the marketplace in 2015, Anthem is the only company selling plans on the marketplace in 2014, and is applying the narrow network to plans it sells off the marketplace next year, too. Almost all independent insurance plans in the state are bought from Anthem.

Without the narrow network, individual premiums could have risen as much as 50 percent from this year, due in large part to an expanded list of required benefits, and offering coverage to individuals who were previously uninsured or part of the state’s high-risk pool, said Lisa Guertin, Anthem’s president in New Hampshire.

The company kept the rate increase lower by negotiating lower reimbursement rates with 16 of the state’s 26 acute general care hospitals plus one Massachusetts hospital.

Concord Hospital CEO Mike Green said the rates were too low for his organization’s long-range viability, and that Anthem wouldn’t entertain counter-offers. Southern New Hampshire Health System in Nashua and Valley Regional Hospital in Claremont are also among the facilities not included in the network.

Altogether, about 10 percent of Anthem’s customers next year will be covered by a narrow network. For Kattef and Snyder, it’s a network that doesn’t include the doctors they know or the hospital closest to them.

Add in the fact that the plans available on the marketplace will likely be more expensive than the ones they have now, and they’re not happy.

“It’s one thing to raise out-of-pocket maximums . . . if you lower monthly premiums. But I’m going to see a huge increase in premiums too, and oh, just to rub salt in the wound, I’m also losing access to my doctors and hospitals,” Kattef said.

“I don’t want to sound like an entitled spoiled brat by saying I have to drive another 25 minutes to go to the hospital. There’s an actual impact on care when you have to change doctors and the doctors have to learn your whole history over again. I’m not anti-free market. Just give me the option to pay for what I need.”

Both Kattef, 37, and Snyder, 27, said they have been purchasing individual health insurance to avoid becoming a “statistic,” another bankruptcy case traced back to medical debt incurred without insurance.

Snyder first purchased health insurance in 2011, two years after starting her own online marketing agency.

She’s been successful enough to have saved a small nest egg, and had seen what her self-employed parents went through with medical billing even when they had insurance, she said.

Her current policy has a $6,000 deductible, but that’s worth it to her if it means in the worst-case scenario, she won’t face hospitalization bills of more than $50,000, she said.

When she got a letter from her insurance agent about the new network changes, she tried to find out if other companies will sell plans off the marketplace that will work with Concord Hospital.

The hospital told her to call the state insurance department. The department told her to call the hospital.

“That was a fun little run-around,” she said.

One of the touted benefits of buying plans on the marketplace are tax credits toward the cost of the premiums, for people making as much as 400 percent of the federal poverty level, or $45,960 for a single person.

Snyder expects she won’t be eligible for those credits next year. Even if she was, she can’t name the price cut she’d need to be happy driving farther from home and building a relationship with a new doctor.

Neither can Kattef, who retired early from the financial world in New York City and moved to Hopkinton. He and his wife have been buying insurance from Anthem since 2010.

Their deductible that year was $2,500, he said.

At first, Kattef thought his long relationship with Anthem might mean his plan was exempt from the changes. Plans purchased before March 23, 2010, the date the Affordable Care Act passed, are considered “grandfathered” and will be unaffected by the coming changes.

But in 2011, Anthem raised the premium on his plan so sharply, Kattef switched to a plan with an even higher deductible to lower his premium. The switch effectively ended the exemption.

He’s been attending meetings and hearings where state officials discuss the coming changes.

He’s looking for plans outside the marketplace, too, but for now, he isn’t putting too much time into the search, and he’s staying philosophical about the big picture, he said.

“I’m not against the efforts of the Affordable Care Act. I hope it helps the people it’s supposed to help,” he said, “because I’m getting screwed. . . . The baby in the bathwater is me.”



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



This story has been edited to reflect the correct deductible of Josh Kattef’s 2010 insurance plan, $2,500. The deductible figure was incorrect in an earlier version.




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