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April 30. 2014 9:12PM

Woman’s complaint about Anthem's 'narrow network' to be heard

Anthem Blue Cross Blue Shield will have to defend the selection of hospitals for its “narrow network” on the Obamacare website at healthcare.gov now that the state insurance commissioner has scheduled a hearing on the complaint of a Rochester woman whose hospital was excluded.

Insurance Commissioner Roger Sevigny issued an order on Wednesday allowing a Frisbie Memorial Hospital patient to proceed with a hearing on May 14.

The patient, Margaret McCarthy, said that Anthem’s provider network for plans sold on the federally operated New Hampshire Health Insurance Marketplace can’t be considered adequate unless Frisbie is allowed to join.

McCarthy maintains that she has suffered an injury because she qualifies for a federal subsidy under the Affordable Care Act, but cannot use the subsidy without purchasing a policy on a network that, she said, should have never been recommended for federal certification by the Insurance Department in July.

A hearing on McCarthy’s case originally had been set for April 22, but was delayed while Sevigny considered Anthem’s claim that she did not have standing and that her petition was not filed in time. Anthem is the only insurance company selling health insurance policies on the New Hampshire exchange. Two other health insurance companies are expected to join next year — Harvard-Pilgrim and Minuteman Health.

Sevigny said he fully considered Anthem’s objection, but found that McCarthy’s request was timely because she “did not know until Oct. 9 that the July 31 recommendation would directly affect her right to purchase a subsidized plan, or if she would be eligible for a federal subsidy.”

“We are aware of today’s ruling by the N.H. Department of Insurance and are in the process of reviewing the petition to determine next steps,” Anthem spokesman Christopher R. Dugan said in a written statement.

Politicians of all stripes have been pushing for the decision.

Senatorial candidate Scott Brown on April 16 released a letter he wrote to Sevigny, urging an expedited hearing.

On April 24, Republican gubernatorial candidate Walt Havenstein called on Democratic Gov. Maggie Hassan to move the matter forward.

“Maggie Hassan should not be waiting around for her insurance commissioner to make a decision,” he said.

First District U.S. Rep. Carol Shea-Porter has also been pushing for the hearing.

“I’m pleased that Margaret McCarthy and the Frisbie Hospital community will be able to address Anthem’s narrow network in an adjudicative hearing,” she said. “Consumers must have their voices heard.”

Hassan also applauded the move through a spokesman.

“She appreciates that the Insurance Department has moved forward with the process for adjudicatory hearings as outlined in law in order to ensure that all parties are treated fairly,” wrote William Hinkle in an email.

Sevigny has said the network proposed by Anthem met the state’s definition of adequacy as it currently exists, but he has convened a working group to revise the rules that define a minimum “adequate network” for health insurance plans.

More than 20 participants representing a range of stakeholders — including consumers, health care providers, nonprofit health care advocates and insurance companies — met for the first time on April 23.

The process will culminate in new guidelines for network adequacy, which will be subjected to public hearings and submitted to the state Legislature’s Rules Committee. The Insurance Department’s goal is to have the new standards in effect by next spring, in time for 2016 health plans.

The public hearing on McCarthy’s complaint is scheduled for 9 a.m. Wednesday, May 14 at the Insurance Department, 21 S. Fruit St., Concord.dsolomon@unionleader.com


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