- Associated Press - Wednesday, May 14, 2014

CONCORD, N.H. (AP) - One Rochester woman’s struggle to find affordable health insurance isn’t enough of a reason to broaden New Hampshire’s provider network under the Affordable Care Act, attorneys for the state Insurance Department and Anthem Blue Cross and Blue Shield argued Wednesday.

The arguments came during an Insurance Department hearing for Margaret McCarthy, a patient at Frisbie Memorial Hospital seeking to overturn the approval of Anthem’s narrow network for individual policies purchased under the federal health care overhaul law.

Commissioner Roger Sevigny will decide whether McCarthy was harmed by his department’s approval and whether the network should have been deemed adequate without including her doctors and local hospital.

McCarthy argues that she was harmed because she can’t access the federal subsidy that she qualifies for to pay for her premiums unless she purchases a plan that excludes Frisbie hospital. Her policy expires Aug. 1.

“I was hoping there would be other carriers available by August of 2014, but it doesn’t appear that is going to happen until January, so that is going to leave me with five months of I don’t know what to do,” she said. “It’s made me very anxious because my choice is a policy I can afford or a policy that I can’t afford that will let me see my doctors.”

Anthem and the department have said the network - which includes 16 hospitals, 78 percent of the state’s primary care providers and 87 percent of specialists - meets or exceeds all state standards, including the maximum distance allowed between patients and providers.

For primary care, at least 90 percent of a county’s population must have access to doctors within 15 miles of home. The percentage is 100 percent in McCarthy’s county.

They also argued that McCarthy wasn’t harmed because she could have renewed her plan early last fall and extended it until 2016, or could have purchased a plan from a much smaller insurance company whose network included Frisbie.

“The petitioner has demonstrated nothing this morning,” said Richard McCaffrey, an attorney for the department.

Anthem is the only company that offered health plans through the new marketplace during the first enrollment period that ended March 31. Company 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.

Sevigny did not indicate when he will make a decision but gave the three sides until May 28 to submit documents supporting their arguments.



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