Anthem takes heat from N.H. senators over limited provider network for marketplace plans

Last modified: 9/19/2013 12:21:59 AM
The president of Anthem Blue Cross Blue Shield in New Hampshire faced an unhappy audience of state senators yesterday as she defended the insurer’s plan to exclude 10 of New Hampshire’s hospitals from the limited network of health care providers available for people who purchase insurance through the new exchange.

“You’re obviously hearing how frustrated the senators are as a group. Every single one of us (is) exceptionally, exceptionally disappointed in this,” Sen. Andy Sanborn, a Bedford Republican, told Lisa Guertin, Anthem’s president in New Hampshire.

Guertin met with Sanborn and more than a dozen other senators for nearly 90 minutes at the State House to discuss the plans it will offer starting Oct. 1 on New Hampshire’s new insurance exchange, a feature of President Obama’s 2010 health care reform law.

Anthem is the only insurance company planning to sell coverage through New Hampshire’s exchange in 2014, though Harvard Pilgrim Health Care has said it will join the marketplace in 2015.

Guertin said Anthem sought to reduce the cost of its plans by reducing the number of participating providers. Participating hospitals, she said, accepted lower reimbursement rates because they’ll gain patient volume in a narrow network.

The plans Anthem will sell to individual customers and through the exchange cover services at 16 of the state’s 26 acute general care hospitals plus one Massachusetts hospital; Concord Hospital and the Southern New Hampshire Health System in Nashua are among the hospitals not included in the narrow network.

“This is not a minimalist network,” Guertin said. “More than 90 percent of our potential customers will be within 20 miles of a short-term general hospital. That’s twice as good as what’s required, or allowed, under the law. . . . We weren’t seeking to make this, you know, ridiculously skinny, narrow and bare bones.”

The provider network for about 90 percent of Anthem customers will remain the same, the company said. People who receive coverage through an employer won’t be affected, except for small businesses that opt to buy coverage through the new Small Business Health Options Program, or SHOP exchange.

Anthem plans to offer 11 different plans, with different levels of co-insurance and deductibles as “bronze,” “silver” and “gold” plans. Premium rates vary considerably depending on a person’s age, whether they buy a plan through the exchange and whether they get any federal tax credits, based on income, to subsidize the purchase.

For example, a 21-year-old making 300 percent of the federal poverty level, or $34,470 a year, would pay a monthly premium of $177 for the “bronze” individual plan through the exchange. Premiums for the same plan, at the same income level, come to $227 for a 40-year-old and $482 for a 60-year-old, though those people could use the subsidy to reduce their premiums to $210 and $140, respectively.

Senators at yesterday’s meeting expressed a number of concerns about the plan – especially the exclusion of certain hospitals, some of which said they were never contacted about possible participation in the narrow network.

Sen. Bette Lasky, a Nashua Democrat, was critical of Anthem’s decision to include Nashua’s St. Joseph’s Hospital but not Southern New Hampshire Health System. St. Joseph’s “does not provide full reproductive services to women,” she said.

“I just don’t understand how you can choose a hospital that doesn’t service full needs of the women in a huge population center,” Lasky said.

Sen. Sam Cataldo, a Farmington Republican who had knee surgery this summer, said the only two New Hampshire hospitals that provide that service aren’t included in the narrow network.

“You’re not helping at all, the stuff I’m looking at, as far as these knees, anybody’s knees,” he said. “You picked and (chose), and I don’t like that at all.”

Guertin replied, “I understand it’s imperfect. It isn’t perfect. But I do believe it’s in the greater good.”

Also confronting Guertin at yesterday’s meeting was Alvin Felgar, president and chief executive officer of Rochester’s Frisbie Memorial Hospital, which isn’t in the narrow network.

He said Anthem’s representatives wouldn’t even speak with the hospital’s leaders about participating in the network.

“This is not fair,” Felgar said.

Anthem isn’t likely to add more hospitals to the network, Guertin said yesterday, given the hospitals participating now were persuaded to accept lower reimbursement rates in large part by the promise of getting more patients in a narrow network.

“I believe we would see some of the originals say, ‘I’m out of here,’ and we would end up, at this 11th hour, with a spotty network that doesn’t cover the map effectively. . . . The worry is that, at this date, with no one else out there in the exchange, if we did that, and all of a sudden five hospitals say, ‘That’s not what you said to me, that’s not what you promised me,’ where would we be?” Guertin said. “That’s my worry, and I don’t know how you mitigate that risk.”

(Ben Leubsdorf can be reached at 369-3307 or or on Twitter @BenLeubsdorf.)

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