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Frisbie hospital seeks hearing on network exclusion, information denial

New Hampshire Union Leader

December 05. 2013 12:53AM

ROCHESTER — Frisbie Memorial Hospital is at odds with the state Insurance Department over the release of information on the criteria used by Anthem to decide which hospitals to include in the "narrow network" the health insurance company created for the Obamacare website — a network that excluded the Rochester hospital and nine others in the state.

Frisbie has petitioned the Insurance Department for a hearing and an order requiring Anthem to add Frisbie as a network provider if it is willing to accept the same terms as the other hospitals in the network.

Frisbie attorneys followed that petition with a right-to-know request for information the hospital says is needed to prepare its case.

The department denied the request, citing the confidentiality of "propriety information" belonging to Anthem, according to Frisbie President and CEO Al Felgar.

Felgar said the hospital will appeal the denial at an Insurance Department hearing that has been approved but not yet scheduled.

He criticized the lack of transparency in the process by which the Anthem network was developed and approved. "The entire process was handled behind closed doors," he said. "Now the documents are being kept under lock and key, and that is not fair."

Frisbie has argued that the network should not have been approved as presented by Anthem because it is inadequate for basic service coverage, especially in the North Country.

"Since we have been blocked from the basic information about the network, we have no way of knowing what the state Insurance Department has reviewed or done to determine if these products meet basic adequacy for New Hampshire families," Felgar said. "There was never any public scrutiny of the key factors that went into deciding which providers in New Hampshire would be a part of Anthem's narrow network."

Jennifer J. Patterson, legal counsel for the Insurance Department on life, accident and health insurance, said the department is still reviewing Frisbie's right-to-know petition.

"We have released a substantial amount of material, and are still reviewing remaining material to determine whether it should be released," she said.

Felgar does not see it that way.

"The only information we have received regarding network adequacy is a series of spreadsheets showing the raw data of the number of patients and providers in New Hampshire," he said. "That is neither helpful nor informative."

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