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February 10. 2014 9:51PM

Rochester hospital brings busloads to Insurance Department Obamacare hearing

CONCORD — The attorney representing one of the hospitals left out of Anthem’s “narrow network” for the Obamacare website in New Hampshire accused the insurance company of trying to marginalize the poorest patients in the interest of profitability.

“That is the very population that Obamacare was intended to reach,” said Jeremy Eggleton, representing Frisbie Memorial Hospital in Rochester.

At the conclusion of a four-hour informational hearing before the senior staff of the state Insurance Department on Monday, Eggleton said the department approved Anthem’s network even though it did not meet standards set by state law for adequate coverage, and did so in a closed-door process.

Eggleton’s presentation was the last of four segments in a hearing that included presentations by Insurance Department staff, a question-and-answer session, and testimony by more than 20 stakeholders, mostly in support of Frisbie Memorial and Monadnock Community Hospital in Peterborough, which are not included in Anthem’s Obamacare network.

Current and former patients, health care practitioners, insurance agents, policy experts and hospital employees were among those who crowded into the Department of Environmental Services auditorium on Hazen Drive to urge the Insurance Department to reconsider its approval of the Anthem network.

Many of them called on the department to work with the Legislature to change the law so that insurance companies cannot exclude any hospital that is willing to accept the same payment terms offered to others.

Some told personal stories of health care crises that could have turned tragic if not for the availability of care at nearby local hospitals, prompting one Insurance Department official to point out that anyone in need of emergency care can go to any hospital, in or out of the network, and still be covered.

CEO requested hearing

Al Felgar, Frisbie’s chief executive officer, has led the charge by hospitals left out of the Anthem network, which affects only those who purchase insurance through the Obamacare online exchange at healthcare.gov.

Felgar requested the hearing about Anthem’s failure to include Frisbie and nine other hospitals in its network, and threatened a lawsuit if he didn’t get one. Two busloads of Frisbie employees and supporters unloaded in front of the auditorium as the hearing got under way.

Anthem has repeatedly said it established the narrow provider network to reduce premium costs, and contends its network of 16 of the state’s 26 hospitals meets all state requirements.

The network includes about 75 percent of all primary care doctors and 85 percent of specialists, according to Anthem.

“More than 90 percent of our customers are on commercial plans (outside of healthcare.gov) that still have the broad network,” said Anthem spokesman Christopher R. Dugan, after the hearing. “It’s because of the (Pathways) network we’ve built that we’re able to offer premiums that are 30 percent less than they would be with the broad network.”

Assertion challenged

The Insurance Department said it had no choice but to approve the plan because it met the letter of the law.

Eggleton challenged that assertion, arguing that the department overlooked omissions in Anthem’s application. “The department had a special burden to ensure this network was adequate,” he said. “Had Anthem been required to submit all the necessary information, the network would have been deemed inadequate.”

Insurance Department staffers suggested in their presentation that much of the data could not be provided because there was no actual consumer experience with the Pathways network.

Eggleton said Anthem has sold health insurance in the state for more than a decade, and could have provided reasonable estimates on patient waiting times, travel times and the availability of primary care physicians who are still accepting new patients.

“The data was there if they wanted to use it,” he said. “The data was never submitted. At best, the submission was incomplete. The commissioner has the absolute power to correct the situation today.”

Eggleton drew circles in areas around Sullivan, Carroll, Coos and Grafton counties, where large gaps exist between hospitals in the Pathway network.

“Anthem’s network leaves a substantial number of people out in the cold, and they just happen to be in the poorest parts of the state,” he said.

Feb. 27 forum

Insurance Commissioner Roger Sevigny opened the session by telling the crowd that a team of stakeholders is working with the department to revisit the standards for network adequacy with an eye toward legislative recommendations in the near future.

Former state senator Joe Kenney, the GOP candidate for the District 1 Executive Council seat left vacant by the death of longtime councilor Ray Burton, announced plans for a Feb. 27 forum on the narrow network scheduled from 10 a.m. to noon at the Common Man Inn in Claremont.


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