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March 29. 2014 9:41PM

Rochester woman 
to challenge Anthem

CONCORD — The New Hampshire Insurance Department has agreed to hear a Rochester woman's challenge of the adequacy of Anthem Blue Cross Blue Shield's provider network for plans sold on the state health insurance exchange.

In an order issued Friday, Commissioner Roger Sevigny ruled that Margaret McCarthy has standing to challenge the insurer's network for health plans offered on the exchange under the Affordable Care Act.

A hearing is set for April 9 at 10 a.m. at the New Hampshire Insurance Department. Sevigny will preside as hearing officer.

The Insurance Department last year recommended the federal government approve Anthem's plans, despite the fact only 16 of the state's 26 acute-care hospitals were included.

McCarthy is a patient of doctors at Frisbie Memorial Hospital in Rochester, which was excluded from the Anthem plans.

McCarthy said she is "delighted" with the commissioner's decision. "Because I really feel that the state of New Hampshire has sort of let the people of New Hampshire down by allowing this one-sided monopoly to dictate which hospitals or which doctors we can go to," she said. "Especially since we're required to have insurance, it seems like everyone that wants to play ought to be allowed to."

Frisbie Memorial joined with McCarthy to challenge Anthem's network, arguing in documents filed with the Insurance Department that it puts Frisbie at a competitive disadvantage.

When her current coverage expires in August, McCarthy said she has to choose either to change medical providers to enroll in an Anthem plan, or keep her existing doctors and pay more for insurance, because she'd have to forgo the federal subsidies available if she bought a plan through the state exchange, also called the Marketplace.

Late last year, the Insurance Department had ruled that neither Frisbie nor McCarthy had standing to challenge the department's approval of Anthem's health plans.

In January, however, the department agreed to reconsider the petition.

In Friday's order, Sevigny affirmed his earlier decision that Frisbie has no standing to appeal, noting "the network adequacy standards do not require that an insurance carrier contract with any particular medical provider, or that any particular enrolled participant have access to any particular provider."

However, he changed his mind about McCarthy, concluding she has standing to appeal "as a consumer who claims to have been harmed by the circumstance that there is only one Marketplace provider and that this provider has an inadequate network which can only be made adequate by the inclusion of Frisbie."

His decision, he wrote, "rests on the fact that Anthem is the only carrier offering plans in the Marketplace, and that buying a Marketplace plan is the only way to access federal subsidies."

McCarthy, 62, said she has "multiple" doctors in Rochester who have been treating her for years. Under the existing Anthem network on the insurance exchange, she said, "I have to drive past my hospital and my doctors if I want to find a doctor that's on the Anthem plan."

She said Anthem has made the case that it did not know it was going to be the only insurance carrier participating in the exchange when it set up its narrow network. "And that may be true, but the state of New Hampshire knew that they were the only insurance carrier that was going to be in New Hampshire, and I feel that they didn't do their job in making sure there was a fair network set up," she said.

Sevigny wrote that his order should not be seen as a ruling on McCarthy's underlying claim. And he said Anthem has the right to file a motion to intervene in the proceedings.


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