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April 07. 2014 2:26PM

Anthem hearing on Frisbie’s exclusion from exchange network postponed

CONCORD — Insurance Commissioner Roger Sevigny has issued an order postponing the April 9 adjudicative hearing set for a Frisbie Memorial Hospital patient who claims that Anthem’s narrow network for plans sold on the federally operated exchange cannot be deemed adequate unless Frisbie Hospital is allowed to join.

Sevigny’s decision to postpone the hearing comes in response to a motion filed by Anthem, which asserts that Margaret McCarthy’s request for a hearing was untimely and that the Insurance Department was mistaken in granting her standing to make her claim, according to Department Enforcement Counsel Richard McCaffrey.

Commissioner Sevigny’s April 4 decision states that the department will consider Anthem’s position that McCarthy’s claim was untimely and he will make a final decision on Anthem’s claim by April 15, McCaffrey said.

If Sevigny concludes that McCarthy’s request was, in fact, timely, her hearing with the department will be rescheduled for April 22.

“The April 4 order gives Ms. McCarthy the opportunity to respond to Anthem’s argument that she appealed too late,” said McCaffrey, who would be assigned to present the department’s position at the hearing, while Sevigny would act as presiding hearing officer, considering both sides’ arguments and issuing a final decision.

If Sevigny decides that the appeal was timely, then the hearing will take place April 22.

In November, Frisbie Hospital and McCarthy filed a petition with the department alleging that Anthem’s network was inadequate and they sought a hearing to present their claims.

The petition also asked the Insurance Department to order Anthem to include Frisbie in the Marketplace provider network. In December, Sevigny denied the petition, finding that the hospital and McCarthy lacked standing to challenge the network because the department does not have the authority to order Anthem to contract with Frisbie, McCaffrey said.

Following Sevigny’s Dec. 11 ruling, the petitioners requested a rehearing, stating this time that Anthem’s plans cannot meet network adequacy standards unless they include Frisbie in the provider network, McCaffrey said.

In January, the N.H. Insurance Department granted the petitioners’ request to reconsider the December ruling in order to allow them to argue their new claim.

On March 28, Sevigny found that McCarthy does have standing to request a hearing because she now claims to be able to prove that Anthem’s network can only meet adequacy standards if Frisbie is in the network, McCaffrey said.

The March 28 order affirmed the Insurance Department’s previous ruling that Frisbie Hospital can't challenge the department’s determination because it is not “a person aggrieved by any act or impending act … of the commissioner.”

Should Sevigny rule that McCarthy’s request was timely and decide to reschedule her adjudicative hearing, it will take place at 10 a.m. April 22 at 21 S. Fruit St., Concord, and would be open to the public.


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