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Peterborough

MCH looking at its options

Frisbie initiates Anthem lawsuit

PETERBOROUGH — Attorneys for Frisbie Memorial Hospital in Rochester are seeking a hearing to review Anthem Blue Cross Blue Shield’s plan to limit the network of hospitals it will work with under the Affordable Care Act. Meanwhile, Monadnock Community Hospital, which was also excluded from Anthem’s network, is looking at its options for eventually participating in the federal health program.

Last week, Frisbie officials asked the state’s Department of Insurance to review the plan that Anthem submitted to provide coverage under the ACA. Anthem’s Pathway network of 18 New Hampshire hospitals and one Massachusetts hospital did not include Frisbie, Monadnock Community or eight other small New Hampshire hospitals. As result, Monadnock-area residents who want to buy insurance through the ACA exchange may have to travel to hospitals or doctors that are further away, although Cheshire Medical Center in Keene will be participating in Anthem’s program.

Alvin Felgar, the chief executive officer of Frisbee Memorial, once held the same position at Monadnock Community Hospital. He said Monday that Anthem’s narrow network could pose a real threat to the small hospitals in the state. The danger, Felgar said, is that Anthem, which is the only company offering an ACA network in New Hampshire, might eventually start directing all of its insurance business through the Pathway network. Without those patients, he said, hospitals that have to rely on Medicare and Medicaid payments would have difficulty surviving financially because those reimbursements are lower than Anthem has offered.

“It doesn’t take much imagination to start connecting the dots,” Felgar said. “We have legal action under way. We’ll get as many people to a hearing as we can, because this has to be stopped.”

Felgar said no date for a hearing has been set.

Peter Gosline, chief executive officer at Monadnock Community Hospital, said hospital officials will be keeping a close eye on the hearing process, although MCH is not part of any legal challenge to Anthem’s proposal.

“We are aware of what they are doing,” he said about the Frisbee effort. “I do share their concern in terms of access as well as choice. I can’t walk downtown without people seeking me out, asking if they’ll be able to keep their doctor. There’s a lot of concern locally about people losing their choice.”

Gosline said he has had discussions with Anthem officials and the Department of Insurance about how MCH can eventually participate in the Pathway network

“We’re trying to find out if there are any alternatives,” Gosline said. “For 2014, we’re not aware of options. For 2015, we want to be part of a network and still have reasonable reimbursements.”

Rich Scheinblum, chief financial officer for MCH, said Monday that the hospital has about 40,000 people in its coverage area. He estimates that between 2,000 and 2,500 of those people will be eligible to participate in the health exchange network. He said within that group, about 1,000 may be losing coverage that they currently have, as Anthem and other insurers phase out coverage options that don’t meet the Affordable Care Act standards. Others in the group are currently uninsured and could choose the Pathways network, although Scheinblum said it’s expected that about 40 percent of those without coverage will choose to pay penalties under the Affordable Care Act.

“Our physicians are very concerned that folks they have cared for for years may have to leave,” Gosline said. “With Anthem, we’re keeping all options on the table. They have made commitments statewide and I haven’t heard of any willingness on their side to change those commitments.”

Laura Gingras, the hospital’s vice president of community relations, said most of the people affected by loss of existing coverage have individual policies or polices through small employers of less than 50 people. She said anyone concerned about losing coverage should contact their insurance broker or company promptly.

“Right now, there’s only the one option on the exchange, but there are other ways for people to keep their health care providers,” Gingras said. “It’s important that they contact their insurance carrier to learn what their options are.”

Dave Anderson can be reached at 924-7172, ext. 233 or danderson@ledgertranscript.com. He’s on Twitter at @DaveAndersonMLT.

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