Nashua clinic in contract impasse with Anthem

In what appears to be a growing trend, another New Hampshire health provider is accusing Anthem Blue Cross and Blue Shield of strong-arm tactics in its contract negotiations and Anthem is saying the provider is guilty of imposing super-sized charges.This time, the state’s largest health insurer is pitted against the Counseling Center of Nashua, one of the largest providers of behavioral health services in the state, currently treating approximately 10,000 patients.As early as Thursday, March 3, the Counseling Center said, 3,240 Anthem patients may be without behavioral health coverage if an agreement cannot be reached. Anthem, however, said patients will be covered through May 2.Dr. Evan Greenwald, president and director of the center, said it canceled its contract with the insurer a month ago after reaching an impasse.He said Anthem is looking for deeper cuts in provider reimbursement rates from its providers. The center, for its part, claims that Anthem pays as much as 25 percent less than Blue Cross and Blue Shield of Massachusetts for identical services.Greenwald said Anthem has “some issue with us charging too much,” but Anthem said it is being more than fair with reimbursing the Counseling Center.According to Chris Dugan, spokesperson for Anthem, “the Counseling Center is currently being reimbursed well above its peers, and is asking for an increase above that. We do not feel that’s fair to other patients and providers.”That doesn’t necessarily mean all Anthem patients lose all coverage, according to Dugan.”Depending on the plan, some patients may have an out-of-network benefit, others may not and may not be reimbursed for care,” said Dugan.Greenwald said a change in billing practices was “the first incident that got things going.”According to Greenwald, the center had been paid directly by BCBS of Massachusetts for years for care of its members until last April. The New Hampshire Insurance Department he said, told the center “that we needed to be billing Anthem” and not the Massachusetts company, said Greenwald.BCBS then said, ‘Whoops! We shouldn’t have been doing this. Stop billing us. You need to bill Anthem,'” according to Greenwald.Upon the advice of lawyers, he said, the center continued to bill BCBS of Massachusetts.That’s when BCBS of Massachusetts demanded again, according to Greenwald, that the center stop billing directly and wanted $60,000 for care it reimbursed the clinic after the initial notice, threatening legal action.Adding to the confusion is that, while BCBS of Massachusetts is completely unrelated corporately to Anthem (a WellPoint entity covering the Blue plans of 14 states including New Hampshire), BCBS of Massachusetts uses Anthem as sort of a third-party payer for behavioral services rendered to its members seen in New Hampshire.Greenwald claimed that Anthem pays 8 percent to as much as 25 percent less than BCBS of Massachusetts for identical services.”There is a sort of ‘interstate compact’ between them where we are required to bill the local insurance carrier,” said Greenwald. “It’s a 25 percent pay cut to us.”Dugan said it was Anthem’s policy not to comment on active negotiations, but added: “What we want patients to know is that they have coverage through May 2,” said Dugan.Dugan also said the insurer is currently taking a closer look at the billing process.Greenwald said the center requested meetings with Anthem to discuss the reimbursement rates, suggesting perhaps matching those it previously received from BCBS of Massachusetts.”Anthem is not really even talking to us,” said Greenwald. “They say we already have an ‘exception contract’ and that we’re already charging too much. ‘So don’t even talk to us about changing them.'”That so-called exception contract, he said, stems from the center’s contract with Behavioral Health Network, which was bought out by WellPoint in 2007.When NHBR asked if higher than customary reimbursement rates was an issue, Greenwald said, “They do have some issue with us charging too much.”Greenwald said the center requested a 60-day continuance of contracted care from the New Hampshire Department of Insurance during the dispute, but he said the request was denied.A meeting with representatives from both sides was scheduled for later this week, but was postponed until March 9, according to Greenwald. – CINDY KIBBE/NEW HAMPSHIRE BUSINESS REVIEW

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