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Column: Anthem Shouldn’t Be Allowed to Exclude Valley Regional

Claremont

A lot of misinformation is floating around the community about Anthem’s decision to exclude certain hospitals, including Valley Regional, from the insurance plans it is offering on the New Hampshire health exchange for small businesses and individuals. This is obviously cause for great concern for our patients, for businesses and for the community at large. As the CEO, board chairman and chief of the medical staff of Valley Regional, we thought we would share a few facts and our perspective.

Anthem Blue Cross Blue Shield, a for-profit insurance company and the only insurer operating through the health exchange, has excluded Valley Regional and a number of other hospitals from its network of providers who will be covered by the plans its sells on the health insurance exchange. Anthem appears to be seeking to serve only the most healthy and therefore the most profitable patients and families across New Hampshire. With Valley Regional being the dominant provider of health care in Sullivan County, Anthem has effectively excluded many county residents as well as those in other New Hampshire communities where health needs tend to be greater.

Sadly, this is not the first time Anthem has made a move of this sort. In the past, Anthem has made patients travel more than 150 miles for lab work or two hours for surgery with a physician they do not know. Meanwhile, Anthem exports millions of dollars in profit from New Hampshire every year (more than $100 million in some years).

It is disturbing to us that state regulators have allowed this for-profit company to ignore the people most in need of access to this insurance — those who are now required to obtain their insurance through the exchange. We do not believe Anthem’s decision to exclude us is based on quality or cost, as Valley Regional scores high on both accounts.

Here are some facts:

∎ Valley Regional was never approached by Anthem to participate in this network.

∎ For Valley Regional patients who will be insured by Anthem through a policy obtained on the exchange, only care provided in our emergency room will be covered. According to information we have received, any other care provided by Valley Regional will be an out-of-pocket expense for the patient.

∎ To gain access to “in-network providers,” some Sullivan County patients will have to travel upwards of 40 minutes for their care. This includes visits to their primary care provider, all specialists and in-hospital care (outside of the emergency room).

∎ While the Sullivan County residents covered by Anthem insurance offered on the exchange represents a small part of Anthem’s portfolio, we estimate it could represent more than $450,000 of lost business to Valley Regional and would deprive patients of local, high quality care.

∎ When the president of the United States campaigned, he promised that people would not need to change their doctor under the Affordable Care Act. Anthem and regulators followed the letter, but not the spirit, of the law, in defining an “adequate network” for those obtaining insurance on the state exchange.

∎ By excluding Sullivan and large parts of Coos counties, Anthem is avoiding the communities in most need of this insurance exchange. These also happen to be two regions with large numbers of people in the insurance high-risk pool.

We do not believe it is a coincidence that a for-profit insurance company figured out how to avoid the neediest people and highest-risk segments of the population. Sullivan County is the second poorest region in the state. It is well known that those who must now obtain insurance through the exchange are less likely to have access to transportation or have the time to travel long distances for their health care and thus will more than likely not get the care they need.

We are reaching out to the public, media and our local legislators to help ensure members of our community have adequate access to care without having to give up their doctor, travel long distances or pay more out of their pocket. Let your voice be heard! Call your local lawmakers and tell them to take action by not letting state regulators allow Anthem to neglect the citizens of Sullivan County and the other communities across the state excluded by this new plan.

You can also help us help you. Call the office of the president of Valley Regional at 603-542-7771; we want to hear your story. If you are thinking about purchasing insurance from the exchange, you need to know the facts. But you also have a right to get your care locally. We need to mobilize and gather the information to help the Legislature understand what the effects of this limited network are going to be.

Take a stand, be an educator, make a difference!

Michael Fuerst is the board chairman, Charles Sawyer, M.D., is chief of staff and Peter J. Wright is the president and chief executive officer of Valley Regional Healthcare in Claremont.