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Uncertainty surrounds Anthem and network of hospitals

Kevin Landrigan in a Nashua Telegraph article wrote that “State Senators grilled executives with Anthem Blue Cross/Blue Shield of New Hampshire” at a briefing last week.

Senate President Chuck Morse of Salem in scheduling the meeting said, “Senators have heard from constituents, patient advocates, business owners and others since Anthem announced their network reductions …” The issue is over how 14 hospitals get to provide services to policy holders in New Hampshire’s Health Insurance Exchange being created under the Affordable Care Act, often called Obamacare, but 12 other hospitals will not be included in the Anthem network.

The ACA is very complicated. And it has big financial consequences for businesses, individuals and governments. And for individuals without insurance who wish to move to the new exchanges, the ability to access care may not be easy.

The impact of the new exchange insurance policies, I emphasize, does not hit seniors on Medicare, current Medicaid beneficiaries or those who have employer paid insurance. The consumers who will be served by the new Anthem network will be individuals signing up for health insurance in our new federally managed exchange. Depending on income, an individual’s policy may be subsidized to keep the costs affordable.

Among hospitals not in the new network are Valley Regional Hospital in Claremont, Alice Peck Day in Lebanon, Concord Hospital and Monadnock Community Hospital in Peterborough. In some cases, Anthem never gave these hospitals a chance to be in the network. Anthem essentially determined what rates they would pay and then presented their offer to hospitals they selected based on geography and other criteria.

The promise made about the ACA was that beneficiaries could keep their physician. The new Anthem network will restrict beneficiaries to get care from doctors at Anthem’s chosen hospitals. That may not be the same doctor they see today.

Just think about it. How easy is it for a patient living in Claremont who has been seeing a doctor at Valley Regional Hospital to get to appointments with a new doctor in Keene, Lebanon or New London?

Lisa Guertin, President of Anthem New Hampshire, answered saying “If we aren’t willing to live with some disruption and some change, we are never going to be able to change that (second highest health care insurance premiums in the country).” The goal is clear: drive down costs to the insurer to help drive down costs of the policies for government and policy holders.

That means Anthem will be paying lower rates than comparable commercial insurance would pay but by guaranteeing more patients to the hospitals in the network. The hospitals should make out better financially. Concord Hospital said no way. They found the rates were too low and decided not to join the network. The issue is why accept payment rates that will likely cost you money for each patient served. Other hospitals disagree.

My two questions at the briefing were simple. I paraphrased from an email from Peter Wright, CEO of Valley Regional Hospital, to his board of trustees, asking if it was possible that Anthem never contacted the hospitals left out of their new network. The answer from Lisa Guertin was yes. They did not contact the hospitals they did not want in the network and are not open to negotiating with them now for fear that the hospitals who have signed up would reconsider and drop out.

The second question was based on what I was told in a private meeting with one of our top state leaders. When I met with that person on Sept. 12 and expressed my disappointment with the Anthem strategy, I was told “at least we were able to pressure them to include two hospitals in the North Country.”

I asked Ms. Guertin if Anthem can bow to political pressure to include two hospitals in the North Country, how about some hospitals in my area. Ms. Guertin was quick on her feet.

She said it was not political pressure but new information that made them include two additional hospitals in the Anthem network. That came after she had told us about all the actuaries and other experts that had been involved and how their network was based principally on geography. One can believe what they will.

Under ACA/Obamacare, at least for 2014, Anthem is calling the shots as the only carrier offering insurance products in the new exchange. What was supposed to be a marketplace will be a monopoly for the first year. To seal the deal, the day before our briefing the federal authorities approved the Anthem plan.

Individuals can sign up for policies beginning on Oct. 1. The insurance goes into force starting on Jan. 1.

Bob Odell, a Republican, is the New Hampshire senator representing Antrim, Bennington and Francestown, among other towns.

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