Anthem Mum on Why Hospital Was Left Out

Concord — A New Hampshire hospital executive said Wednesday he is being denied access to information about why his facility was excluded from the Affordable Care Act’s provider network for individuals, but the state insurance department said it is still sorting out what it can release.

Al Felgar, president of Frisbie Memorial Hospital in Rochester, is fighting Anthem Blue Cross and Blue Shield of New Hampshire’s decision to exclude his hospital from its network for those purchasing individual policies.

He asked the insurance department last month for a hearing on the matter and for documents Anthem submitted to the state when seeking approval for the network. The department has said it will hold a hearing, but Felgar said Wednesday he hasn’t been able to get the documents.

“The entire process was handled behind closed doors,” he said. “Now the documents are being kept under lock and key, and that is not fair.”

Jennifer Patterson, the insurance department’s attorney, said that wasn’t the case. Under state law, such information is considered confidential, she said, unless the insurance commissioner determines that releasing it would be in the public’s best interest. The department is still making that determination, she said.

“It’s premature to say they’re not going to get any information, because we’re still reviewing that,” she said.

Patterson said the hearing hasn’t been scheduled yet because the department also is determining what kind of hearing the hospital is entitled to. The commissioner can hold an informational hearing any time, she said, but the hospital must persuade the department that it is a wronged party to be granted a more formal hearing.

Anthem is the only New Hampshire insurance company participating in the new online insurance markets required under President Obama’s health care overhaul law. The new network will include 74 percent of the state’s primary care providers, 85 percent of specialists and 16 of the state’s 26 acute-care hospitals.

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, because network hospitals agreed to reimbursement rate concessions in exchange for the promise of a certain volume of patients.