Anthem, St. Joseph Hospital dispute could mean higher medical bills if not settled by March 1

Jan. 2—State insurance officials are requesting that Anthem Blue Cross and Blue Shield and St. Joseph Hospital in Nashua meet for "a facilitated discussion" next week to try and break a "concerning" contract standoff that could mean higher hospital bills starting on March 1.

"The ramifications of this dispute extend to tens of thousands of Granite Staters," the state Insurance Department said Thursday. "This prolonged dispute is highly unusual and concerning."

Negotiations have stalled "primarily due to disagreements over reimbursement rates and alleged payment discrepancies," the Insurance Department said.

State law requires Anthem to treat its patients at St. Joseph Hospital as in-network until March 1.

After March 1, "St. Joseph Hospital would be considered out-of-network and ... patients who are covered by Anthem commercial plans may pay higher, out-of-pocket expenses when they receive care at our hospital, outpatient clinics, or provider practices," the hospital said.

Emergency care will remain covered as in-network, the Insurance Department said.

Anthem, the state's largest health insurer, said the dispute "affects approximately 7,000 Anthem members with individual, employer-based, and Federal Employee Program coverage. Anthem Medicare Advantage members are not affected."

That number includes any family members covered as well, according to Anthem.

Both sides in the dispute accuse the other of asking for too much during prolonged negotiations before their contract expired Wednesday.

"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," the insurer said in a statement.

The hospital suggested the opposite.

"The rates Anthem is offering are lower than those provided to other health systems in New Hampshire," the hospital said. "Accepting rates that are out of line with the real cost of delivering care undermines our viability," the hospital said on its website.

The hospital said its top issues include: Anthem agreeing to terms that follow industry standard policies regarding claims administration and payment and the insurer "reducing inappropriate denials for reimbursement."

State insurance officials said both sides have indicated they want to continue negotiations.

"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," they said.

"This disruption comes at a critical time when individuals have already made their health plan choices for 2025," Insurance Commissioner D.J. Bettencourt said in a statement. "Patients — including pregnant mothers, dialysis patients, and those undergoing cancer treatment — face unnecessary upheaval in their health care continuity due to this dispute."

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