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Frisbie Hospital Patient Granted Hearing On Anthem's Network

Via Flickr CC

After several stops and starts, the Insurance Department has agreed to a formal hearing on the adequacy of Anthem’s narrow network of hospitals.

The move stems from a complaint filed by East Rochester resident Margaret McCarthy. She says she’s been aggrieved by Anthem’s decision to exclude Frisbie Memorial Hospital from its network for plans sold through the Affordable Care Act.

“The patient, Margaret McCarthy, claims that Anthem’s provider network for plans sold on the federally operated New Hampshire Health Insurance Marketplace cannot be deemed adequate unless Frisbie Hospital is allowed to join the network,” said Insurance Department Enforcement Counsel Richard McCaffrey. “Ms. McCarthy claims she has suffered an injury because although she alleges she qualifies for a federal subsidy under the Affordable Care Act, she cannot access this subsidy without purchasing a policy whose provider network was, she claims, improperly recommended for federal certification by the Insurance Department in July of 2013.”

The hearing is scheduled for May 14th, with a pre-hearing conference slated for May 8th.

Frisbie filed its own petition with the Insurance Department, which Commissioner Roger Sevigny denied. Congresswoman Carol Shea-Porter applauded today’s ruling by Sevigny granting McCarthy a hearing.

“I’m pleased that Margaret McCarthy and the Frisbie Hospital community will be able to address Anthem’s narrow network in an adjudicative hearing. Consumers must have their voices heard,” writes Shea-Porter in a statement.

Anthem had challenged the timing of McCarthy’s complaint.

Both Frisbie and McCarthy are represented by the same law firm. 

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.

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