Insurer’s limited health network prompts NH bill

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CONCORD, N.H. (AP) - Insurance companies selling policies under the Affordable Care Act in New Hampshire would be required to negotiate with all willing health care providers, under a bill before the state Legislature.

Just one company - Anthem Blue Cross and Blue Shield of New Hampshire - is currently offering health insurance in the new markets required under President Barack Obama’s health care overhaul. Its provider network includes 74 percent of the state’s primary care providers and 85 percent of specialists, but just 16 of the state’s 26 acute-care hospitals.

The chief executives of two excluded hospitals told a House committee Tuesday that they should’ve at least been given a chance to negotiate with Anthem.

“I wanted to join the network, and I still do, but I never had a chance to participate in the process. Decisions about the network were made privately, and now Frisbie, its patients and its doctors are on the outside looking in,” said Al Felgar, president of Frisbie Memorial Hospital in Rochester. “All we are asking for is a chance to prove we can provide quality and affordable care within the network.”

The bill’s sponsor, Rep. Bill Nelson, R-Nelson, said he was motivated not by politics but by a desire to correct an injustice that is affecting thousands of residents.

“This bill is about fairness. It’s about monopolies, about jobs, and about the patients that are inconvenienced by the extra travel and expense,” he said. “Competition is good, but I also see unfairness in the system as it stands.”

Anthem officials have said the main driver in selecting providers was geography - more than 90 percent of the plans’ potential customers live within 20 miles of a network hospital, though under the law, that distance could’ve been twice as far and still considered adequate. They said including all hospitals would have driven up premiums by about 30 percent because network hospitals agreed to reimbursement rate concessions in exchange for the promise of a certain volume of patients.

Paula Rogers, Anthem’s director of government affairs, noted that lawmakers also will be considering bills to require at least one hospital in every county to be included or to require that two public hearings be held before any insurance product sold through the marketplaces is approved. But she suggested a better approach might be revisiting the state’s criteria for determining network adequacy.

“We’re concerned about legislation that may, while well-intentioned, move in a direction that is not as comprehensive as necessary, and I don’t exactly know what’s necessary. I just know certainly things need to be reviewed,” she said.

Tyler Brannen, health policy analyst at the state Insurance Department, said the department is not taking a position on the bill, though it has concerns about whether it would end up in the middle of disputes over whether an insurer has engaged in “good faith” negotiations with providers. He also urged lawmakers to look beyond hospitals when thinking about whether patients have appropriate access to care, given the health care industry’s rapid evolution.

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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