Show Us the Fine Print
A good doctor cannot make a proper diagnosis without all of the major facts. Same with health care providers. Frisbie Memorial Hospital's managers are struggling to deal with the major reforms of the Affordable Care Act. But they don't have the facts. Frisbie Memorial Hospital has been frozen out of Anthem's narrow network in New Hampshire, and as of last week, Frisbie has been denied any access to the most critical information regarding how Anthem decided which hospitals were in...and which were out. "The entire process was handled behind closed doors," explains Al Felgar, President and CEO for Frisbie Memorial Hospital. "Now the documents are being kept under lock and key, and that is not fair."
In response to a right to know request from Frisbie Hospital, the NH Insurance Department denied access to these critical documents, saying the information is confidential because it relates to the department's power to examine proprietary information of insurance companies.
"Because of this new law, we have essentially been told that we can no longer provide care for people who enroll in the Insurance Exchange under the ACA. These are the same people we have taken care of for years, "says Al Felgar. "But we are not allowed to even review how that decision was made because the state won't let us see the details in the process. This is unfair."
Frisbie commends the NH Insurance Department for working to provide basic information about the network. But by blocking any information about network adequacy denies a fair review of all of the facts. Frisbie will soon plead its case to the New Hampshire Department of Insurance in a special hearing, which has been approved, but has yet to be scheduled.
"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," explains Felgar. "That is neither helpful nor informative. 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. We call on the Insurance Commissioner to reverse the decision for the good of our patients."
Frisbie Memorial Hospital believes the state's definition of network adequacy fails on two levels. First, basic service coverage of the state's patients is NOT adequate, especially in the North County. Second, the numbers of doctors and hospitals is inadequate to cover the state's patient base.
"Since we have been blocked from the basic information about the network, we have no way of knowing what state insurance department has reviewed or done to determine if these products meet basic adequacy for New Hampshire families," says Felgar. "By not gaining access to Anthem's narrow network, a wedge is being driven between patients and doctors at Frisbie Memorial Hospital."
"There was never public scrutiny of this process," says Felgar. "The Insurance Department's confidentiality reflects the choice not to allow the public any access to this process."
Frisbie asks NH Dept. of Insurance to reconsider withholding critical Anthem network documents
Release Date: December 04 2013