Anthem CEO grilled over narrow network that excludes 10 hospitals


As the reform law ushers in a new wave of health plans with narrow networks, insurance execs find themselves at the receiving end of many public questionings.

The latest insurer to feel the backlash of its decision to offer a narrow network plan is Anthem Blue Cross Blue Shield of New Hampshire. Its plan includes 74 percent of the state's primary care providers, 85 percent of specialists and just 16 of the state's 26 hospitals, according to the Associated Press.

"What we've done as one insurer in the marketplace is create an offering that we really believe represents the best value and the best balance of access and affordability," Anthem President Lisa Guertin said at a state Senate hearing Wednesday.

In attempting to curb costs, Anthem decided to drop the number of participating providers, who agreed to lower their reimbursement rates, some by as much as 25 percent, because their patient volume will increase with fewer competitors in the network, the Concord Monitor reported.

Anthem wants its costs to drop because New Hampshire has the second highest premiums in the country, Guertin said. "Disruption is hard, change is hard," she said. "If we're not willing to live with some disruption and some change, we're never going to be able to improve that."

However, Guertin said the new plan isn't a "minimalist network," since 90 percent of all potential customers will still be within 20 miles of a hospital. "We weren't seeking to make this, you know, ridiculously skinny, narrow and bare bones," she said.

Guertin also faced strong opposition from some senators, who are particularly concerned that Anthem's narrow network plan lacks adequate services for women. Sen. Bette Lasky, D-Nashua, said Anthem's in-network hospital for Nashua doesn't offer full reproductive services, including access to abortion referral counseling or contraception services. "I don't understand how you can choose a hospital that doesn't serve the full needs of women in a health center," Lasky said, reported the Nashua Telegraph.

Although Anthem's plan excludes many hospitals, Guertin emphasized that members with chronic conditions can ask that they retain their current provider outside of the network.

To learn more:
- read the Associated Press article
- see the Concord Monitor article
- check out the Nashua Telegraph article

Related Articles:
Narrow network plans could drive up costs
Harvard Pilgrim launches shared-risk, narrow network plan
Hospitals slam Highmark for limited network plan
Most exchange plans limit member choices
Minn. Blues partners with provider for new narrow network plan
Anthem wins state regulatory approval to create narrow network plan