Dive Brief:
- A New Hampshire hospital is fighting to get into Anthem Blue Cross and Blue Shield's new narrow network for ACA plans.
- Frisbie Memorial Hospital in Rochester, one of 10 hospitals booted from the narrow network that goes with Anthem's ACA plans, alleges that the health plan submitted an incomplete application to state regulators, and that regulators, in turn, didn't give the application a hard enough look.
- Anthem officials say that the main criterion for selecting providers was geography, but that network hospitals also agreed to reimbursement rate concessions in exchange for getting patient volume.
Dive Insight:
Though the state's Insurance Department denied Frisbie's request, it did release hundreds of documents Anthem submitted and is holding a hearing Monday to explain its process, according to the Associated Press. According to the article, the hospital plans to argue that the Department of Insurance didn't get enough information to properly evaluate the proposed narrow network, and that it wouldn't have approved the proposal if it had all of the information. Regardless of how this turns out, I anticipate many battles of this kind over the next several months. Hospitals aren't going to go down easy.