UPDATE: Anthem Blue Cross and Blue Shield provided the following statement about ongoing negotiations:
“We are currently in discussions with St. Joseph Hospital to reach a new agreement that keeps their doctors and hospital in our network and improves healthcare affordability. Already one of the most expensive hospitals in New Hampshire, St. Joseph Hospital is demanding to drastically increase the prices it charges its patients covered by Anthem.
“We hope to reach a new long-term contract that keeps St. Joseph Hospital in our network for years to come. Although St. Joseph Hospital let our prior agreement expire on January 1, 2025, we will continue to cover services there through March 1, 2025 as provided for by state law.”
Members with questions may visit anthem.com/stjosephnh or call Member Services at the number on their Anthem ID card for assistance.
NANCY WEST, InDepthNH.org
NASHUA – Saint Joseph Hospital in Nashua is alerting patients that as of Jan. 1, 2025, they are no longer part of Anthem’s insurance network, according to the New Hampshire Insurance Department.
The department issued a public statement Thursday saying there is an ongoing and escalating contract dispute between the hospital and Anthem, New Hampshire’s largest health insurance carrier.
Approximately 8,000 to 10,000 patients are likely to be directly impacted, according to the Insurance Department.
“However, it is unclear whether this figure includes individuals who access care at St. Joseph outside of the services provided in the hospital, such as those receiving care at their other outpatient facilities,” according to responses to questions to an Insurance Department spokesman.
The estimate also does not account for individuals who chose their health plans in the individual market based on St. Joseph Hospital being in-network, nor does it include businesses that enrolled their employees in specific plans based on St. Joseph Hospital being included in the network.
Anthem Medicare Advantage plans will not be affected.
Negotiations between Anthem and St. Joseph Hospital aim to establish a new contractual agreement to reinstate St. Joseph Hospital in the network. The parties retain the ability to negotiate a contract even after a previous contract expires, a spokesman said.
The hospital has issued a letter to patients, dated December 30th, 2024, available at https://stjosephhospital.com/patients-visitors/anthem-updates.
New Hampshire law states that, “Within 5 business days of the contract termination, the health carrier shall provide written notice to affected covered persons explaining their continued access rights.”
The requirement of the carriers to provide notice to consumers is enforced by the NHID.
Anthem didn’t respond to an email request seeking more information.
“In August 2024, the NHID became aware of a potentially significant impasse in contract negotiations between the two entities. Negotiations have now stalled for nearly two years, primarily due to disagreements over reimbursement rates and alleged payment discrepancies. This prolonged dispute is highly unusual and concerning,” according to the Insurance Department news release issued Thursday.
“…Earlier this week, Commissioner DJ Bettencourt provided an update on the matter in a letter addressed to Nashua-area lawmakers and Governor Sununu.
“This disruption comes at a critical time when individuals have already made their health plan choices for 2025,” said Bettencourt. “Patients—including pregnant mothers, dialysis patients, and those undergoing cancer treatment—face unnecessary upheaval in their healthcare continuity due to this dispute.”
Anthem is required by state law to continue paying claims at in-network rates for 60 days following notification, according to the Insurance Department news release. “However, many patients require ongoing care beyond this period, making it imperative for both parties to work collaboratively to ensure smooth transitions for affected patients,” the release said.
Emergency care will remain covered as in-network, and consumers are protected by federal and state laws against balance billing.
“The NHID has formally requested a facilitated discussion between the parties, scheduled for next week. While the department does not have the authority to compel negotiations or agreements, it will provide data, resources, and guidance to support a potential resolution. Both Anthem and St. Joseph Hospital have indicated a willingness to continue negotiations, and the NHID is committed to ensuring that process takes place,” the Insurance Department said.
“I urge both parties to prioritize the health and well-being of New Hampshire residents,” added Bettencourt. “Time is of the essence, and the consequences of inaction are serious.”
Consumers with questions or concerns are encouraged to contact the NHID Consumer Services Division at 603-271-2261 or visit https://insurance.nh.gov.
