Hospitals fight back against provider network exclusions

Frisbie Memorial Hospital in Rochester, N.H., one of 10 hospitals ousted from Anthem Blue Cross Blue Shield's provider network for individual health plans, is fighting to rejoin the ranks of participating providers, the Associated Press reported. Frisbie claims that Anthem submitted a factually incomplete application to state regulators, who then approved the insurer's narrowed network anyway.  

This case is the latest volley in the ongoing debate about an Affordable Care Act implementation trend of restricting networks to providers that accept lower rates in return for high patient volumes. 

Cost-conscious exchange shoppers may accept the trade-off of fewer provider choices for lower premiums, as FierceHealthPayer recently reported.

Meanwhile, the federal government has frowned on excessive network cuts: The Centers for Medicare & Medicaid Services proposed a new policy requiring payers to expand their networks to include 30 percent of essential community providers in their areas or risk being kicked out of the marketplaces.

At issue in the Frisbie case is whether the state's insurance department followed a requirement to ask Anthem to determine which network providers accept new patients. Documents Anthem sent to the regulator don't address this point, an AP review found.

"If none of those providers are accepting new patients, then that's not a very useful thing for all these new patients who are getting insurance on the exchange," Frisbie's lawyer Jeremy Eggleton told the AP.    

New Hampshire's insurance department denied Frisbie's reconsideration request. Even if the regulator reversed its approval of Anthem's thinned network, it couldn't force Anthem to contract with Frisbie, insurance commissioner Roger Sevigny told the AP. Without commenting on the hospital's complaints, insurance department's attorney Jennifer Patterson told the AP that Anthem's network application review followed proper procedures.

Anthem spokesman Christopher Dugan told the AP that the insurer complied with all laws and regulations and met or surpassed network requirements.  

And state positions differ on network trimming. Concerns about this caused Maine regulators, for example, to prohibit Anthem from transferring some members into its narrow network plan sold on the exchange that excludes six state hospitals.

For more:
- read the AP article