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Health care networks, hospitals at odds once again

State House Bureau

June 19. 2014 9:50PM

CONCORD — Health care networks established by insurers who sell policies on the state health insurance marketplace are again an issue.

Littleton Regional Hospital officials said the hospital was dropped from Anthem Blue Cross Blue Shield in New Hampshire’s health provider network after saying it could not agree to lower rates than the insurer pays this year.

Anthem, the only insurer on the marketplace this year, established a network that does not include 10 of the state’s 26 hospitals in order to reduce premiums.

This year, Anthem’s network for individual and small business policies sold on the state exchange includes 17 hospitals. However, the state’s dominant health insurer added three hospitals to the network while two hospitals — Littleton and Elliot in Manchester — are no longer in the network.

Christopher R. Dugan, Anthem’s public relations director, characterized the two hospitals as declining to join the insurer’s network for 2015.

“We had hoped to maintain same the network in 2015, but some of the providers declined to re-contract with us,” he said.

Littleton had not originally been included in Anthem’s network when it was announced last fall, but was added after state and local officials urged the company to include the facility because it was the only birthing center in that area of the state.

The president of Littleton hospital, Warren West, said his hospital was willing to accept the same rates for both the individual and small business programs but Anthem wanted to reduce rates for the Small Business Health Options Program, or SHOP exchange policies.

“They told me if you don’t take a reduction in the SHOP product you will not be allowed to participate in the Pathway product (individual market),” West said. “We want to be in Pathway but we can’t afford to take any more reductions in rates because of how fragile the critical access hospitals are in this state.”

West said Anthem made a counter proposal, but it would have cost the hospital more to administer than it would have received in fees.

The hospital did not know it had been officially dropped from Anthem’s network until reading it in the Union Leader, he said.

Dugan said negotiations with hospitals are confidential, but noted 90 percent of the company’s business is group policies that do not use the smaller network and utilize all state hospitals.

Dugan said the Pathway network is for individual policies sold through the marketplace.

“We hope all our customers continue to use our products, but we recognize they do have choices out there,” Dugan said. “We offer a good balance between affordability (and) access to quality health care, but they do have choices.”

West said of particular concern are pregnant women who have to make choices if their baby is going to be born after Jan. 1.

The only birthing centers in the North Country are Littleton, Androscoggin Valley Hospital in Berlin and Cottage Hospital in Woodsville, which is closing its birthing center in January.

Without Littleton, pregnant women in the North Country will have to go to either Berlin or Dartmouth-Hitchcock in Lebanon, he noted.

“Anthem is putting patients’ health in jeopardy because of a lack of a network in the North Country,” West said. “Statistically, the North Country is the least healthy part of the state and most economically challenged. Transportation is difficult for them so their health care has to be local.”

Time is of the essence, he noted, because there are expectant mothers who will need to change their doctor and hospital if they are going to have their babies after Jan. 1. Other local patients will need to change doctors and hospitals as well, West said.

He noted the hospital has agreed to the rates offered by the other insurers who approached the hospital.

West said he is hopeful the hospital can continue to work with Anthem and has a face-to-face meeting with Anthem’s leaders at the end of the month.

“We want to serve patients in the North Country with the local care they deserve because many of them cannot afford to travel the distance required because of the networks put in place for 2015,” West said. “We are always willing and able to negotiate with anybody, but it’s difficult to negotiate with any firm that tells me it’s a take (it) or leave it proposition.”

This week the state Insurance Department released preliminary proposals from five insurance companies who will be on the 2015 marketplace, saying every hospital in the state will be included in at least three insurer networks.

Littleton is included in four of the five insurers’ networks, but not Anthem’s.

“Our goal in building Pathway was to achieve a price position that is attractive to consumers while meeting network adequacy requirements,” said Lisa M. Guertin, president of Anthem Blue Cross Blue Shield in New Hampshire, after the networks were released. “We strongly feel we are meeting that objective based on enrollment figures that are well above projections and therefore our goal remains unchanged in 2015.”

State Insurance Commission Roger Sevigny said Tuesday the health care provider networks are likely to change before the products are offered on the marketplace beginning in November as insurers continue to negotiate with hospitals.

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