Thousands of patients may have to switch to new health care providers, due to a contract dispute between St. Joseph Hospital in Nashua and Anthem Blue Cross Blue Shield.
St. Joseph Hospital and Anthem, the state’s largest insurer, are at odds over how much the hospital should be paid for its services. St. Joseph also alleges Anthem is regularly denying claims that should be covered, echoing complaints other hospitals have made about the company in recent years.
Despite negotiating for more than a year, St. Joseph and Anthem failed to reach an agreement by Jan. 1 – meaning the hospital is no longer in-network. The hospital said this could affect about 7,000 patients who rely on Anthem for coverage.
“Despite nearly 15 months of good-faith negotiations, we have been unable to reach an agreement with Anthem/Blue Cross Blue Shield of New Hampshire that reflects the exceptional care and services delivered by St. Joseph Hospital,” hospital spokesperson Tim McMahon said in a prepared statement.
The change will not affect patients immediately, as state law requires Anthem to continue paying in-network rates until March 1.
Anthem says its members can continue seeking care as normal at St. Joseph Hospital until that time. Both parties say negotiations are still ongoing, and they hope to reach an agreement before March.
The change will not impact people with Anthem Medicare Advantage plans. Emergency care will also remain in-network.
In a statement Thursday, New Hampshire Insurance Commissioner D.J. Bettencourt called the dispute “highly unusual and concerning.” He said his agency plans to convene the two parties for a “facilitated discussion” next week in hopes of resolving the issue.
“This disruption comes at a critical time when individuals have already made their health plan choices for 2025,” Bettencourt said. “Patients — including pregnant mothers, dialysis patients, and those undergoing cancer treatment — face unnecessary upheaval in their healthcare continuity due to this dispute.”
The news was a shock to Amy Wadland, a Merrimack resident who described herself as a lifelong patient of St. Joseph. She’s worried about trying to find appointments with new doctors, if thousands of other Anthem patients are switching providers at the same time.
She may also need surgery for Crohn’s disease; she’s now thinking about delaying it until she can switch to a different insurer next fall, to stay with her current doctors.
“Just shocked that our insurance company can just drop, completely drop, hospitals and all their providers,” she said. “I would never have seen this coming.”
One of the main disagreements centers on reimbursement rates. In a Q&A on its website, St. Joseph Hospital says Anthem is offering rates that are “out of line with the real cost of delivering care” and lower than what other health systems get.
St. Joseph also alleges Anthem has an “unusually high rate” of denying claims, though they did not specify a percentage. In recent years, hospitals in New Hampshire have raised concerns about unpaid claims, unwarranted denials and other issues with Anthem – allegations the company denies.
For its part, Anthem says it’s offered “reasonable and fair payment” in line with what it pays other providers – and St. Joseph is demanding unreasonable increases that would drive up costs for patients and employers.
“We hope to reach a new long-term contract that keeps St. Joseph Hospital in our network for years to come,” Stephanie DuBois, a spokesperson for Anthem, said in a statement. “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.”
