Failed deal between insurer and Nashua hospital sparks N.H. involvement

CONCORD, N.H. — The New Hampshire Insurance Department is getting involved in what state officials called an escalating contract dispute between St. Joseph Hospital in Nashua and Anthem Blue Cross Blue Shield, the state’s largest health insurance carrier.

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State officials called the impasse “highly unusual and concerning,” and warned it could affect tens of thousands of New Hampshire residents.

Anthem’s contract with the hospital ended on Dec. 31, and as of March 1, patients with Anthem insurance will have to find other providers or pay the out-of-network rate, which could be cost prohibitive. Anthem has to keep paying claims at in-network rates for 60 days through March 1, which is required by state law. Emergency care will remain covered at in-network rates, according to the Insurance Department.

“This disruption comes at a critical time when individuals have already made their health plan choices for 2025,” DJ Bettencourt, commissioner of the New Hampshire Insurance Department, said in a statement.

“Patients — including pregnant mothers, dialysis patients, and those undergoing cancer treatment — face unnecessary upheaval in their healthcare continuity due to this dispute,” he said. He said a meeting has been set for next Tuesday and both Anthem and St. Joseph have agreed to participate.

The department estimates there are at least 8,000 to 10,000 patients receiving care at the hospital who would be directly affected. St. Joseph also provides services at non-hospital facilities like outpatient clinics, and Bettencourt said it’s not yet clear how those people would be impacted.

The main dispute between St. Joseph and Anthem was over how much the hospital could charge the insurance for various health care procedures, with St. Joseph attempting to negotiate higher rates and Anthem trying to keep costs down, Bettencourt said. There were also disputes over past payments, with the hospital arguing it hadn’t been paid enough and the insurer claiming it had been charged too much, according to Bettencourt.

“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,” said a statement from Anthem Blue Cross and Blue Shield.

The department cannot force an agreement between the two, officials said, but it can provide data, resources, and guidance to help reach a resolution.

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“I urge both parties to prioritize the health and well-being of New Hampshire residents,” said Bettencourt. “Time is of the essence, and the consequences of inaction are serious.”

Timothy J. McMahon, the director of marketing for St. Joseph Hospital, confirmed that hospital officials are negotiating with Anthem.

“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 and that ensures access to care for Anthem members,” said a statement from the hospital.

“Our goal is to negotiate with Anthem to finalize a new contract so we can continue to serve our patients,” the statement said, adding that about 7,000 St. Joseph Hospital patients who have commercial coverage plans through Anthem will be affected. It said patients with Anthem Medicare Advantage plans will not be affected.

The hospital has set up a dedicated phone line (833-681-6900) for patients who are directly impacted, and Anthem is providing information at https://www.anthem.com/stjosephnh/.

Amanda Gokee can be reached at [email protected]. Follow her @amanda_gokee.