- Associated Press - Monday, March 24, 2014

CONCORD, N.H. (AP) - The New Hampshire Insurance Department is taking the first step toward changing how it decides whether insurance companies are offering adequate networks of doctors and other providers.

The department said Monday it will hold an organizational meeting April 23 for a working group that will review the state’s network adequacy rules and make recommendations to the Legislature.

Insurance Commissioner Roger Sevigny first mentioned the working group last month, at a public hearing requested by Frisbie Memorial Hospital. The Rochester facility is one of 10 New Hampshire hospitals excluded from the provider network for policies purchased under the federal health care overhaul law.

Anthem Blue Cross and Blue Shield is currently the only company selling health plans through the new online marketplace, though two more are expected to join next year. The insurance department on Monday issued a license to Minuteman Health, a new Massachusetts-based nonprofit cooperative hoping to offer coverage through the marketplace. Harvard Pilgrim, already licensed in the state, also is expected to begin offering plans in 2015.

Though patients and some hospitals have complained, Anthem and the insurance department say the company’s network meets or exceeds all state adequacy standards. Anthem officials have said that including all hospitals would have driven up premiums because network hospitals agreed to reimbursement rate concessions in exchange for the promise of a certain volume of patients. Frisbie Hospital officials counter that they would have been willing to accept low reimbursement rates but weren’t even given a chance to negotiate.

The hospital wants Sevigny to order Anthem to negotiate with all willing providers. Sevigny has declined to do so, but said the working group could result in rules changes that would become effective in 2016.

“We understand that there are concerns from citizens about how health insurance companies are able to choose providers within their networks,” he said. “We plan to look carefully at our network adequacy standards in view of new legal requirements, changes in medical practice, and the need to encourage more competition in our health insurance markets. We are committed to engaging in this discussion in an open, transparent manner.”

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