CONCORD — Those insured by Anthem Blue Cross Blue Shield through the state health exchange may have greater choices next year if their hospital and doctor are not in the carrier’s narrow health provider network.
At a public hearing Tuesday on Senate Bill 380, which would require any carrier on the state health exchange to have one hospital in every county in its network, the bill’s sponsors, Anthem and the NH Hospital Association said they are working to rectify the current situation requiring some patients to travel a half an hour or more to see a doctor or go to a hospital.
But they noted, any change would not occur until 2015 and may not be needed if other carriers join the exchange and offer wider networks.
The bill’s prime sponsor, Sen. David Pierce, D-Hanover, said future plans on the exchange may include an out-of-network benefit that would allow the residents of Claremont to go to Valley Regional Hospital and see their doctors instead of travelling to Lebanon, New London or Keene, as they now have to do if they brought insurance through the exchange from the only carrier, Anthem.
“Access to health care is absolutely critical to the people of this state,” Pierce said. “We need a vehicle to keep the pressure on the stakeholders.”
Anthem’s Pathway network, which covers those purchasing health insurance on the exchange, did not include nine of the state’s 26 hospitals including Valley Regional Hospital in Claremont and Frisbie Memorial Hospital in Rochester, which threatened to sue over its exclusion.
Anthem and the Insurance department said when Pathway was announced the network meets all the state requirements, but acknowledged some people would be inconvenienced under the plan that was established to reduce the premium costs.
As a result of the controversy, the Insurance Department put together a working group to study network guidelines and requirements.
The Insurance Department’s Jennifer Patterson said the narrow network was a very real issue with only one carrier on the exchange.
“The situation we believe will be corrected because there should be more market competition in 2015,” she said, but noted requiring one hospital in every county could be a barrier to other insurers entering the market.
Paula Rogers of Anthem said having a hospital in every county may not be the best approach, but noted any change would come in 2015 not this year.
Anthem is about to finalize its plans for the exchange in 2015, noting the deadline for submission to the Insurance Department is May 1. To construct another product to sell alongside what the company plans to offer will take time, she said.
She noted both Harvard Pilgrim and Minuteman say they expect to be on the exchange in 2015 and in 2016 the three managed care organizations that administer the state’s Medicaid managed care program may join the exchange as well.
The federal guidelines are also changing Rogers noted and may require networks to include all “Essential Community Providers” which may mean all acute care hospitals.
Steve Ahnen, President of the NH Hospital Association, told the Senate Health, Education and Human Services Committee the patient is the important thing, noting many low-income patients have a difficult time traveling to receive health care.
“At the end of the day, we have to be sure patients have access to appropriate health where they want it, when they need it and in the way they want,” Ahnen said.
Other bills before the House and Senate address the same issue.
The committee is expected to decide next week what action to take on the bill.