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Anthem Excludes Hospitals

APD, Valley Regional and Cottage Left Out

Lebanon — Officials at Alice Peck Day Memorial Hospital are searching for answers about why they and two other Upper Valley hospitals will not be included in the network of providers covered in the insurance plans offered through New Hampshire’s health insurance exchange.

The Lebanon hospital is among 10 institutions across the state, including Valley Regional in Claremont and Cottage Hospital in Woodsville, that Anthem Blue Cross Blue Shield has excluded from its select network of providers.

The decision will not affect Anthem customers who receive health insurance through their employer, nor individuals who bought plans prior to March 23, 2010, Anthem said. The new network will apply to all individuals that purchase health plans, either on or off the exchange, as well as small businesses that buy insurance on the so-called “SHOP” (Small Business Health Option Program) exchange.

Evalie Crosby, the chief financial officer at Alice Peck Day, said she and her colleagues do not know why APD was excluded and are worried about the consequences it may have for patients.

“A real critical thing for us is that people understand that our not being in the network was not our choice,” Crosby said in an interview this week. “We protested being excluded from the network and do not, absolutely do not, believe it is the right decision for our patients, for our providers and for the community of Lebanon.”

Some insurance analysts have estimated the exchange could cover as many as 150,000 people in the state.

By not being included in the network, APD and the other excluded hospitals will be considered “out of network” providers, which means it will be more expensive to seek care there for people with limited network plans, Crosby said.

Officials at Valley Regional and Cottage could not be reached for comment Thursday.

On Thursday, Anthem defended its decision to limit its network to 16 of New Hampshire’s acute care hospitals, including Dartmouth-Hitchcock and New London Hospital.

Independent studies by the state’s Department of Insurance and the Society of Actuaries predicted premiums would rise as much as 40 percent, driven primarily by higher claims of the previously uninsured and those covered through existing high risk pools, Anthem said. To offset the increase, providers in the network are offering rate concessions for individuals who buy insurance on the exchange.

“Anthem is choosing to offer this select network of providers to offset the premium increases that would otherwise be necessary,” the company said in a statement.

A key provision of the Affordable Care Act, health exchanges are like online shopping malls for health coverage. Individuals and families who do not get health insurance through their employer, and businesses with fewer than 50 employees, will be able to buy health insurance through the exchanges when open enrollment begins in October.

People who do not buy insurance face a tax penalty under the federal law, though there are a few exemptions. In Vermont, the exchange will be the only place where individuals and small businesses can get health insurance. But in New Hampshire, insurance plans can still be purchased outside of the market.

Anthem is the only insurer to offer plans through New Hampshire’s health exchange for the first year and its proposal is still awaiting approval by the federal government.

The decision on which hospitals to include in the network can be changed in future years and Harvard Community Health Plan officials have said they intend to offer coverage in the exchange in 2015.

In an interview Wednesday, Dartmouth-Hitchcock president and CEO Jim Weinstein said the limited network may not be bad for patients if it leads to lower costs and more efficient care.

“I think Anthem may be experimenting,” Weinstein said. “But they may be looking to see how this network works. Do they get better quality? Do they control costs better? I can see limited networks being a very positive thing if it’s around the patients.”

On Wednesday, Anthem officials said that neither Androscoggin Valley Hospital in Berlin nor Littleton Hospital were part of the network, which would have left all of Coos County without access to maternity care, because Weeks Medical Center in Lancaster, while part of the network, does not provide that service.

On Thursday, both Androscoggin and Littleton were added to the list of network providers.

Meanwhile, state officials traded accusations about who should be blamed for the confusion.

A spokesman for Gov. Maggie Hassan said her office has encouraged Anthem to provide information to consumers quickly and share details of how it intends to reduce costs. The spokesman blamed problems with New Hampshire’s exchange on the decision, led by Republicans, to forgo designing its own marketplace and instead cede control to the federal government.

“As has frequently been the case throughout this process, the last Legislature’s misguided law blocking a state-based marketplace has ceded significant control and hampered state-level oversight,” Hassan spokesman Marc Goldberg said in a statement. “At every step along the way, Republicans in the legislature have impeded and obstructed implementation of New Hampshire’s health benefit marketplace, undermining health coverage for New Hampshire’s families, individuals and small businesses, and now they’re trying to play politics with people’s health care.”

In Vermont, which chose to design its own exchange, all the state’s hospitals plus Dartmouth-Hitchcock are included in the network of providers, according to Robin Lunge, director of health reform for the state.

New Hampshire Senate President Chuck Morse, R-Salem, blamed the confusion on President Obama and said the concerns over the limited network are one more example of how the promises Obama made for federal health reform are not coming to fruition.

“When President Obama was selling his national health care plan to the families and businesses of New Hampshire, he assured us that health insurance would be affordable and patients would be able to keep their family doctors,” Morse said in a statement. “Sadly, with each passing day, we are finding that the president’s promises are hollow.”

Information from the Nashua Telegraph and Concord Monitor was included in this report.

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.

CORRECTION

This article has been amended to correct an earlier error. Anthem Blue Cross Blue Shield has excluded 10 New Hampshire hospitals from its network of providers in the plans offered through the state's health insurance exchange. An earlier version of this story was incorrect on the number of institutions.

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Letter: Anthem Never Asked Cottage to Join

Tuesday, September 24, 2013

To the Editor: I would like to clarify a few points about the introduction of Anthem New Hampshire’s prospective network on the health insurance exchange and what it means for Cottage Hospital and the community we serve. The Anthem network (known as Pathways) for the health care exchange, a by-product of the Affordable Care Act, is limited to individuals who …