February 10

Rochester hospital argues against N.H. network exclusion

Frisbie Memorial says regulators didn’t properly scrutinize Anthem's application.

By Holly Ramer
The Associated Press

CONCORD, N.H. — A New Hampshire hospital fighting to get into Anthem’s new narrow network says the insurance company submitted an incomplete application to state regulators, who then approved it without the necessary scrutiny.

Frisbie Memorial Hospital in Rochester is one of 10 hospitals excluded from Anthem Blue Cross and Blue Shield’s provider network for individual plans being sold under the federal health care overhaul law. The state Insurance Department denied Frisbie’s request to reconsider its decision, but it released hundreds of documents Anthem submitted and is holding a public hearing Monday to explain its process. It denies the hospital’s allegations of wrongdoing, as does Anthem.

Jeremy Eggleton, the hospital’s lawyer, said he will argue Monday that the department didn’t get the information necessary to fully evaluate the proposed network, and if it had, it wouldn’t have approved it.

“Not only is this network inadequate from a procedural point of view – the proper documentation was never submitted – but I would suggest the reason that didn’t happen is it’s not network adequate as a matter of substance,” he said.

Anthem officials have said the main driver in selecting providers was geography – more than 90 percent of the plans’ potential customers live within 20 miles of a network hospital, though under state law, that distance could’ve been twice as far. They said including all hospitals would have driven up premiums because network hospitals agreed to reimbursement rate concessions.

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